Mizrahi Meir, Adar Tomer, Orenbuch-Harroch Efrat, Elitzur Yair
Internal Medicine A, Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem IL 91120, Israel.
Case Rep Med. 2009;2009:861370. doi: 10.1155/2009/861370. Epub 2010 Feb 22.
Intravenous immunoglobulins (IVIgs) are used for several indications, including autoimmune conditions. IVIg treatment is associated with several possible adverse reactions including induction of a hypercoagulable state. We report a 76-year-old woman treated with IVIg for myasthenia gravis, which developed chest pain and weakness following IVIg infusion. The symptoms were associated with ST segment depression in V4-6 and elevated troponin levels. The patient was diagnosed with non-ST elevation myocardial infarction (NSTEMI). The patient had no significant risk factor besides age and a cardiac perfusion scan was interpreted as normal (the patient refused to undergo cardiac catheterization). This case is compatible with IVIg-induced hypercoagulability resulting in NSTEMI. Cardiac evaluation should therefore be considered prior to initiation of IVIg treatment especially in patients with multiple cardiovascular risks.
