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a Department of
Rheumatology, Tel Aviv "Sourasky" Medical Centre, Israel, b Department of Neurology, Assaf Harofeh Medical
Centre, Israel, c Department of
Haematology, E Wolfson Medical Centre, Israel, d Department
of Medicine F, Assaf Harofeh Medical Centre, Israel, e Department of Medicine, Tel
Aviv "Sourasky" Medical Centre, Israel
Correspondence to: Dr O Elkayam, Department of Rheumatology, Tel Aviv "Sourasky" Medical Centre, 6 Weizman Street, Tel Aviv 64329, Israel.
Accepted for publication 12 August 1999
OBJECTIVE
To report on
four patients with autoimmune disorders who developed acute myocardial
infarction (MI) during or soon after treatment with high dose
intravenous immunoglobulins (IVIG) and to determine the clinical
profile of patients prone to this complication.
METHODSThe clinical
history of the four patients is reported with details concerning age,
sex, indication for IVIG treatment, risk factors, timing of the MI and
outcome. The relevant medical literature has been reviewed.
RESULTSThe patients,
three men and one woman, aged 42-67, received IVIG treatment for
different autoimmune disorders. All had a history of atherosclerosis or
previous risk factors such as hypertension, stroke, hyperlipidaemia and
obesity. Two of the patients suffered a MI after the first infusion of
IVIG while the othersafter the 5th and 15th pulses. MI occurred
during the infusion in two patients and after a few days in the others.
All the patients recovered from the acute event. These observations are
in concert with sporadic cases of IVIG related thrombosis reported in
the medical literature.
CONCLUSIONIn patients
with vascular risk factors such as old age, hypertension, history of
stroke or coronary artery disease, the possibility of IVIG related
vascular complications should be considered and IVIG prescribed with a
cautious reweighted risk/benefit consideration.
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