title: Incidence and natural history of intravenous immunoglobulin-induced aseptic meningitis: a retrospective review at a single tertiary care center.
abstract: BACKGROUND
  Aseptic meningitis is a rare but significant complication of intravenous immunoglobulin (IVIG) therapy. The majority of literature is limited to case reports, so the true incidence of this complication is uncertain.
  
  
  METHODS
  A retrospective review of all cases of IVIG-associated adverse transfusion reactions was performed at London Health Sciences Centre (LHSC) from January 1, 2008, to December 31, 2013. All reported transfusion reactions were evaluated to identify cases of aseptic meningitis due to IVIG. All documented IVIG infusions and lumbar punctures performed during the study period were reviewed; patients with both interventions were identified and further chart review was performed to identify aseptic meningitis.
  
  
  RESULTS
  During our study period, 1324 unique patients received a total of 11,907 IVIG infusions (554,566 g) for various conditions. Eight cases of aseptic meningitis were identified, suggesting an overall incidence of 0.60% for all patients and 0.067% for all IVIG infusions. Patients presented with symptoms within 24 to 48 hours of the infusion and were treated with antibiotics initially. The reactions were self-limited, as symptoms self-resolved within 5 to 7 days. Treatment was supportive, with subsequent IVIG infusions likely requiring preinfusion medication or possibly a switch in product formulation.
  
  
  CONCLUSIONS
  This review of IVIG-induced aseptic meningitis over a 6-year period identifies a more robust estimate of incidence and risk of 0.60% and 0.067% for all patients and infusions, respectively. Given that this complication can mimic infectious meningitis and cause considerable morbidity, physicians need to be aware of this rare but important condition.
authors.affiliation: Department of Medicine, London Health Sciences Centre, Victoria Hospital.
authors.forename: Vighnesh
authors.identifier: http://orcid.org/0000-0002-3775-2412
authors.initials: V
authors.lastname: Bharath
authors.affiliation: Blood Transfusion Laboratory, London Health Sciences Centre, Victoria Hospital.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Eckert
authors.affiliation: Division of Hematology, Department of Medicine, London Health Sciences Centre, Victoria Hospital.
authors.forename: Matthew
authors.initials: M
authors.lastname: Kang
authors.affiliation: Division of Hematology, Department of Medicine, London Health Sciences Centre, Victoria Hospital.|Canadian Blood Services, London, Ontario, Canada.
authors.forename: Ian H
authors.initials: IH
authors.lastname: Chin-Yee
authors.affiliation: Division of Hematology, Department of Medicine, London Health Sciences Centre, Victoria Hospital.
authors.forename: Cyrus C
authors.initials: CC
authors.lastname: Hsia
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000009:adverse effects*; D015994:Incidence; D008297:Male; D008582:Meningitis, Aseptic / Q000453:epidemiology* / Q000209:etiology* / Q000473:pathology; D008875:Middle Aged; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000706:statistics & numerical data
chemical_list: D016756:Immunoglobulins, Intravenous