title: [A case of acute idiopathic autonomic neuropathy improved by intravenous immunoglobulin].
abstract: We describe a case of acute idiopathic autonomic neuropathy (AIAN) in which intravenous administration of immunoglobulin (IVIg) proved effective. A 32-year-old man was admitted with orthostatic dizziness. Fever and headache first developed 24 days earlier, and persisted for 10 days, when orthostatic dizziness developed and prevented him from walking. Hypohidrosis, constipation and impotence also developed. Neurological examinations revealed no abnormalities. Cerebrospinal fluid obtained showed pleocytosis (26/microl) and an increased level of protein (70mg/dl). A head-up tilt test revealed that blood pressure decreased from 120/60mmHg when supine to 60/ 40 mmHg in a head-up position, and the patient complained of dizziness. Plasma noradrenaline concentration was 26pg/ml when supine and 44pg/ml in a head-up position. Results of MIBG cardiac scintigraphy were normal. Dizziness disappeared after initiating IVIg (0.4 g/kg/day). A head-up tilt test was performed 7 days after IVIg, revealing blood pressures of 106/61mmHg when supine and 103/71mmHg in a head-up position. These results suggest that IVIg should be considered as a choice to treat early AIAN.
authors.affiliation: Department of Neurology, Saitama Medical School.
authors.forename: Kimiko
authors.initials: K
authors.lastname: Yoshimaru
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Nakazato
authors.forename: Naotoshi
authors.initials: N
authors.lastname: Tamura
authors.forename: Toshimasa
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Sayaka
authors.initials: S
authors.lastname: Naitou
authors.forename: Kunio
authors.initials: K
authors.lastname: Shimazu
mesh_terms: D000208:Acute Disease; D000328:Adult; D001342:Autonomic Nervous System Diseases / Q000628:therapy*; D006801:Humans; D007024:Hypotension, Orthostatic / Q000209:etiology; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D008297:Male
chemical_list: D016756:Immunoglobulins, Intravenous