Intravenous immunoglobulin meningism

Two children with idiopathic thrombocytopenic purpura developed aseptic meningitis after receiving intravenous immunoglobulin 1 g/kg/day, with unusual large numbers of leukocytes in the cerebrospinal fluid (62). 

To prevent aseptic meningitis, it has been advised that intravenous immunoglobulin should be infused at a slow rate and that diluted immunoglobulin solutions should be used (58). Aseptic meningitis can be prevented by the administration of propranolol (41,58). In addition, prehydration and an antihistamine have been helpful in some patients (41,58). 

Jolles S, Hill H. Management of aseptic meningitis secondary to intravenous immunoglobulin. BMJ 1998 316(7135) 936. 

Attout H, Mallet H, Desmurs H, Berthier S, Gil H, de Wazieres B, Dupond JL. Meningite aseptique an course d un traitement par immunoglobulines intraveineuses a tres faibles doses. [Aseptic meningitis during treatment with very low doses of intravenous immunoglobulins.] Rev Med Interne 1998 19(2) 140-1. 

Obando I, Duran I, Martin-Rosa L, Cano JM, Garcia-Martin FJ. Aseptic meningitis due to administration of intravenous immunoglobulin with an unusually high number of leukocytes in cerebrospinal fluid. Pediatr Emerg Care 2002 18(6) 429-32. 

Other adverse reactions include lightheadedness [40 ], fainting [39 ], and self-limiting aseptic meningitis, which occurs occasionally 48-72 hours after the first dose [30 ]. One patient with chronic spontaneous urticaria developed symptoms of aseptic meningitis on day 3 of a 5-day cycle of intravenous immunoglobulin the immunoglobulin was withdrawn and the urticaria returned to baseline in 2 weeks [56 ]. 

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