title: Diffuse venous thromboemboli associated with IVIg therapy in the treatment of streptococcal toxic shock syndrome: case report and review.
abstract: Streptococcal toxic shock syndrome (STSS) is a severe invasive disease with a 40-80% mortality rate. Inflammatory cytokines induced by streptococcal pyrogenic exotoxins (SPEs) produce the clinical manifestations of a flu-like syndrome, followed by high fevers and multiorgan failure. Previously published reports have described the use of intravenous immunoglobulin (IVIg) as adjunctive treatment for STSS. However, concerns have been raised about the thromboembolic complications of this therapy. We report a severe case of STSS treated with two adjunctive courses of IVIg complicated by severe bilateral pulmonary thromboemboli. To our knowledge, this is the only reported case of thromboemboli associated with IVIg for STSS. The results of this case support the cautious use of IVIg for STSS and demonstrate the need for controlled trials to determine the appropriate timing, dosage, and course of treatment.
authors.affiliation: Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA. jordan.geller@cshs.org
authors.forename: Jordan L
authors.initials: JL
authors.lastname: Geller
authors.forename: Dani
authors.initials: D
authors.lastname: Hackner
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000009:adverse effects* / Q000627:therapeutic use; D011655:Pulmonary Embolism / Q000139:chemically induced; D012772:Shock, Septic / Q000150:complications* / Q000188:drug therapy; D013290:Streptococcal Infections / Q000150:complications* / Q000188:drug therapy; D013923:Thromboembolism / Q000139:chemically induced* / Q000175:diagnosis; D018616:Ultrasonography, Doppler, Duplex; D020246:Venous Thrombosis / Q000139:chemically induced* / Q000175:diagnosis
chemical_list: D016756:Immunoglobulins, Intravenous