Department of Internal medicine, Medical University Clinic, Kantonsspital Aarau, Aarau, Switzerland.
Clinic for Infectious Diseases and Infection Prevention, Medical University Clinic, Kantonsspital Aarau, Aarau, Switzerland.
BMC Infect Dis. 2024 Sep 4;24(1):916. doi: 10.1186/s12879-024-09809-9.
Transfusion-related acute lung injury (TRALI) is a rare life-threatening complication of blood product transfusion. Intravenous immunoglobulin (IVIG)-related TRALI is scarcely reported.
A 63-year-old male patient suffering from multiple sclerosis treated with half-yearly rituximab infusions, was hospitalized due to dry cough, daily fever and shivering for seven days despite antibiotic therapy. Because of the history of COVID-19 one month prior without the symptoms having improved since, persistent bilateral multifocal areas of ground glass opacities in chest computed tomography and positive SARS-CoV-2 PCR from bronchoalveolar lavage with a cycling time of 30.1 COVID-19 due to long-shedding SARS-CoV-2 under immunosuppression with rituximab was diagnosed. He received treatment with nirmatrelvir und ritonavir and because of diagnosed IgG deficiency additionally a single dose of 20 g IVIG. During the IVIG infusion, the patient acutely developed tachycardia, hypotension, fever, chills, and hypoxemic respiratory failure due to pulmonary edema. TRALI was promptly diagnosed, and the patient was transferred to the intensive care unit for non-invasive ventilation for less than 24 h. The patient was discharged home from regular ward 72 h later in a good general condition and no remaining symptoms of TRALI.
IVIG-related TRALI is a rare but life-threating condition and prompt recognition is lifesaving. Due to an increased use of IVIG not only in long-shedding SARS-CoV-2, an increase of TRALI incidence is expected.
输血相关性急性肺损伤（TRALI）是输血的一种罕见的危及生命的并发症。静脉注射免疫球蛋白（IVIG）相关性 TRALI 鲜有报道。
一名 63 岁男性患者，患有多发性硬化症，每半年接受利妥昔单抗输注治疗，因干咳、每日发热和寒战 7 天而住院，尽管进行了抗生素治疗。由于一个月前有 COVID-19 病史，且自那时以来症状并未改善，胸部计算机断层扫描显示持续双侧多发局灶性磨玻璃影，以及支气管肺泡灌洗液中 SARS-CoV-2 PCR 阳性，循环时间为 30.1，由于利妥昔单抗免疫抑制下长期脱落的 SARS-CoV-2 导致 COVID-19 被诊断。他接受了奈玛特韦和利托那韦治疗，并且由于诊断出 IgG 缺乏症，还额外接受了单次 20g IVIG 治疗。在 IVIG 输注过程中，患者因肺水肿突然出现心动过速、低血压、发热、寒战和低氧性呼吸衰竭。迅速诊断出 TRALI，并将患者转至重症监护病房进行无创通气，不到 24 小时。72 小时后，患者在一般状况良好且无 TRALI 残留症状的情况下从普通病房出院回家。
IVIG 相关性 TRALI 是一种罕见但危及生命的病症，及时识别可挽救生命。由于不仅在长期脱落的 SARS-CoV-2 中使用 IVIG 增加，预计 TRALI 的发病率也会增加。
