title: Reversible ileitis secondary to high dose intravenous immunoglobulin in adult kidney transplant patient treated for acute humoral rejection.
abstract: Use of high dose intravenous immunoglobulin (IVIg) has been associated with necrotizing enterocolitis in late-preterm and term infants treated for severe isoimmune hemolytic jaundice. We present the first adult case of reversible ileitis related to high dose IVIg that occurred during the treatment of acute humoral rejection in a kidney transplant recipient (original nephropathy: lupus). At the third of the 5 days of a 0.4 g/kg/day IVIg infusion, he had periumbilical pain and nausea. Non-iodine injected abdominal computed tomography (CT) demonstrated a major proximal ileitis that was absent 1 month earlier on a previous CT. After the fourth injection, IVIg therapy was discontinued. Clinical and radiological signs disappeared, respectively, 5 and 7 days after IVIg discontinuation. No other causes of ileitis were diagnosed (especially infectious, vascular, or lupus-related bowel disease causes). Usual abdominal pain and nausea during IVIg therapy may be related to sub-clinical ileitis and/or enteritis. As in newborn, such complication has to be diagnosed and IVIg infusion discontinued because of potential evolution to intestinal necrosis.
authors.affiliation: Hospices Civils de Lyon, Department of Nephrology and Renal Transplantation, Lyon Sud Hospital, Pierre-Benite, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Ignace-Girerd
authors.forename: Juliette
authors.initials: J
authors.lastname: Bouffard
authors.forename: Anne-Claire
authors.initials: AC
authors.lastname: Du Besset
authors.forename: Catherine
authors.initials: C
authors.lastname: Giannoli
authors.forename: Rémi
authors.initials: R
authors.lastname: Cahen
authors.forename: Frédérique
authors.initials: F
authors.lastname: Dijoud
authors.forename: Claire
authors.initials: C
authors.lastname: Pouteil-Noble
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Villar
mesh_terms: D000208:Acute Disease; D000328:Adult; D006084:Graft Rejection / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007079:Ileitis / Q000000981:diagnostic imaging / Q000209:etiology*; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D014057:Tomography, X-Ray Computed
chemical_list: D016756:Immunoglobulins, Intravenous