Incidence of cerebral infarction after use of intravenous immunoglobulin (IVIG) for treatment of Guillain–Barré syndrome (GBS) is relatively uncommon. Here, we discuss a case of 30-year-old female who was admitted with a complain of thrombocytopenia after infection with dengue virus, who then developed GBS just after a day of discharge. But her woes did not end there, as the GBS progressed rapidly involving her respiratory muscles, leaving her in need of ventilation assistance. Her condition was further deteriorated by development of cerebral infarction that may have been precipitated by the administration of IVIG during the early course of management.
Key messages: Intravenous immunoglobulin in a GBS patient with a hematological abnormality (dengue) should be used with caution. Therapeutic plasma exchange may be considered for management in cases with variable coagulability.
Murthy J. Neurological complications of dengue infection. Neurol India 2010;58(4):581–584. DOI: 10.4103/0028-3886. 68654.
Chang T, de Alwis JS, Samarasekara N, Rajapakse S. Cerebral infarction 3 weeks after intravenous immunoglobulin for miller fisher syndrome: a case report. J Med Case Rep 2014;8:100. DOI: 10.1186/1752-1947-8-100.
Wilson JT, Hareendran A, Grant M, Baird T, Schulz UG, Muir KW, et al. Improving the assessment of outcomes in stroke: use of a structured interview to assign grades on the modified Rankin scale. Stroke 2002;33(9):2243–2246. DOI: 10.1161/01.STR.0000027437. 22450.BD.
Goldstein LB, Bushnell CD, Adams RJ, Appel LJ, Braun LT, Chaturvedi S, et al. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011;42(2):517–584. DOI: 10.1161/STR.0b013e3181fcb238.
DeWalt DA, Pincus T. The legacies of Rudolf Virchow: cellular medicine in the 20th century and social medicine in the 21st century. Isr Med Assoc J 2003;5(6):395–397.
Liou LM, Lan SH, Lai CL. Dengue fever with ischemic stroke: a case report. Neurologist 2008;14(1):40–42. DOI: 10.1097/NRL. 0b013e3180d0a391.
Pritchard J, Hughes RA. Intravenous immunoglobulin—how to use it practical. Neurology 2001;1:93–97.
Katz U, Shoenfeld Y. Review: intravenous immunoglobulin therapy and thromboembolic complications. Lupus 2005;14(10):802–808. DOI: 10.1191/0961203303lu2168rr.
Meena AK, Khadilkar SV, Murthy JMK. Treatment guidelines for Guillain–Barré syndrome. Ann Ind Acad Neurol 2011;14(Suppl 1): 73–81. DOI: 10.4103/0972-2327.83087.