What is IVIG-induced aseptic meningitis?
Intravenous immunoglobulin (IVIG) is a plasma-derived medicinal product containing purified IgG antibodies used to treat various disorders. Aseptic meningitis is a known, though uncommon, adverse reaction to IVIG therapy. It is a non-infectious inflammation of the meninges, distinct from bacterial or viral meningitis, and is believed to be a drug-induced inflammatory response.
Classic symptoms of IVIG-induced aseptic meningitis
Recognizing the symptoms is crucial. The presentation is similar to other forms of meningitis and typically includes a severe headache, often described as severe and persistent, neck stiffness (difficulty or pain flexing the neck forward), and fever (elevated body temperature accompanying headache and neck stiffness). Other symptoms can include increased sensitivity to light (photophobia), nausea and vomiting, chills, malaise (a general feeling of being unwell), altered mental status (confusion or lethargy), and generalized muscle aches (myalgia).
Timing and resolution of symptoms
Symptoms most often appear within 24 to 48 hours of infusion, though delayed reactions up to a week later have been reported. The condition is generally transient and self-limiting, with symptoms resolving within a few days (typically 3 to 5 days) after stopping the IVIG infusion.
Key risk factors for developing aseptic meningitis
Certain factors increase risk, including high-dose infusions (more commonly associated with higher doses, e.g., 1–2 g/kg), rapid infusion rate (administering IVIG too quickly), a history of migraine headaches (increased susceptibility), dehydration, and underlying autoimmune diseases like SLE.
Comparing IVIG-induced aseptic meningitis to infectious meningitis
Distinguishing IVIG-induced aseptic meningitis from infectious meningitis is critical. A lumbar puncture with CSF analysis is necessary. The table below compares key features:
| Feature | IVIG-Induced Aseptic Meningitis | Infectious (e.g., Bacterial) Meningitis |
|---|---|---|
| Etiology | Drug-induced inflammatory reaction. | Pathogen invades meninges. |
| Onset | Usually within 24–48 hours of IVIG infusion. | Not directly linked to drug administration. |
| CSF Findings (WBC) | Pleocytosis, often neutrophilic initially, then lymphocytic. | Higher pleocytosis, high percentage of neutrophils. |
| CSF Findings (Glucose) | Typically normal. | Usually decreased. |
| CSF Findings (Protein) | Elevated protein is common. | Markedly elevated. |
| Cultures | Negative bacterial, fungal, viral cultures. | Positive bacterial or viral cultures. |
| Prognosis | Generally good, self-limiting. | Potentially severe, requires immediate treatment. |
Diagnosis and treatment
Diagnosis involves a high index of suspicion based on symptoms and recent IVIG infusion. A lumbar puncture is needed to rule out infection. Diagnosis is one of exclusion. Treatment is supportive and involves immediately discontinuing IVIG. Hydration and analgesics can help with symptom relief. NSAIDs or corticosteroids may also be considered. Most patients recover completely.
Preventing recurrence of aseptic meningitis
Strategies to minimize recurrence risk include using a slow infusion rate, ensuring adequate hydration, and using premedication like acetaminophen, antihistamines, or corticosteroids. Switching formulations or transitioning to subcutaneous immunoglobulin (SCIG) may also reduce risk.
Conclusion
Aseptic meningitis is a rare complication of IVIG therapy, characterized by severe headache, neck stiffness, and fever. It is typically self-limiting and resolves within days of stopping the infusion. Risk factors include high dose, rapid infusion, and a history of migraines. Prompt diagnosis and supportive treatment lead to a favorable outcome. Recognizing the symptoms and distinguishing them from infection is paramount. For more detailed information on IVIG adverse events and management, consult resources from organizations like the {Link: American Academy of Allergy, Asthma & Immunology https://www.aafa.org/}.
