Stroke after high-dose intravenous immunoglobulin

We describe a rare case of stroke after intravenous immunoglobulin (IVIg) administration and the first case of its occurrence in Evans' syndrome. Our patient, a 42-year-old man, was admitted with increasing fatigue and generalised lymphadenopathy. He presented with a severe autoimmune haemolytic anaemia, and an angioimmunoblastic T-cell lymphoma was histologically diagnosed. Despite initiation of a combination chemotherapy regimen comprising cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP), an immune thrombocytopenia additionally developed, indicating an Evans' syndrome. In order to control the autoimmune process more rapidly we infused IVIg. Within 12 h the patient developed sensomotoric central nervous symptoms. An nuclear magnetic resonance angiography revealed an ischaemic stroke in the right middle cerebral artery. Within few days the patient partially recovered from his neurological deficits. This serious side-effect supports the strategy of limiting IVIg therapy to clinical situations only where it is clearly justified.