title: Non-ST Elevation Myocardial Infraction after High Dose Intravenous Immunoglobulin Infusion.
abstract: Intravenous immunoglobulins (IVIgs) are used for several indications, including autoimmune conditions. IVIg treatment is associated with several possible adverse reactions including induction of a hypercoagulable state. We report a 76-year-old woman treated with IVIg for myasthenia gravis, which developed chest pain and weakness following IVIg infusion. The symptoms were associated with ST segment depression in V4-6 and elevated troponin levels. The patient was diagnosed with non-ST elevation myocardial infarction (NSTEMI). The patient had no significant risk factor besides age and a cardiac perfusion scan was interpreted as normal (the patient refused to undergo cardiac catheterization). This case is compatible with IVIg-induced hypercoagulability resulting in NSTEMI. Cardiac evaluation should therefore be considered prior to initiation of IVIg treatment especially in patients with multiple cardiovascular risks.
authors.affiliation: Internal Medicine A, Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem IL 91120, Israel.
authors.forename: Meir
authors.initials: M
authors.lastname: Mizrahi
authors.forename: Tomer
authors.initials: T
authors.lastname: Adar
authors.forename: Efrat
authors.initials: E
authors.lastname: Orenbuch-Harroch
authors.forename: Yair
authors.initials: Y
authors.lastname: Elitzur