SHM Converge Scientific Abstract ePoster Gallery-A Case of Intravenous Immunoglobulin-Induced Aseptic Meningitis in a Patient With Erythromelalgia

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This case report describes a 53-year-old woman with chronic small fiber polyneuropathy and erythromelalgia who developed aseptic meningitis after treatment with intravenous immunoglobulin (IVIG) for an erythromelalgia flare. One week after receiving a 5-day course of high-dose IVIG (2 g/kg), she presented to the emergency department with severe headache, nausea, vomiting, diarrhea, body aches, photophobia, and neck stiffness. She was afebrile, and initial examination was otherwise unremarkable.<br /><br />Laboratory and cerebrospinal fluid findings suggested acute meningitis, with elevated white blood cell count and protein but normal glucose. Because infection was a concern, she was started on broad empiric antimicrobial and antiviral therapy. However, respiratory testing, CSF culture, gram stain, viral panel, and neuroimaging were all negative. With no infectious cause identified and given the timing and high dose of IVIG, her meningitis was determined to be aseptic and associated with IVIG administration. Her symptoms improved, antibiotics were discontinued, and she was discharged home.<br /><br />The report emphasizes that erythromelalgia is a rare disorder and that IVIG is sometimes used when first-line therapies fail. Although IVIG is generally well tolerated, adverse effects can include headache, nausea, and rarely aseptic meningitis. This complication is more likely with higher doses, and reported onset can range from 24 hours after infusion to 10 days after the last dose.<br /><br />The authors note that prevention and mitigation strategies include adequate hydration, antihistamines, NSAIDs, slower infusion rates, or switching to subcutaneous immunoglobulin, which may cause fewer systemic side effects. The case underscores the importance of recognizing IVIG-induced aseptic meningitis as a rare but clinically significant complication.

Asset Subtitle

Merry Zhai

Meta Tag

Author List Austin Yu, Heather Wang, Merry Zhai, Sunil Sapru

Category Clinical Vignettes

Concept Erythromelalgia

Concept Intravenous Immunoglobulin

Concept Aseptic Meningitis

Concept Burning Pain

Concept Erythema

Distinguished Non-Finalist

Presenter Organization Rutgers New Jersey Medical School

Presenting Author Merry Zhai

Track Adult

Keywords

aseptic meningitis

intravenous immunoglobulin

IVIG

erythromelalgia

small fiber polyneuropathy

headache

photophobia

neck stiffness

high-dose immunoglobulin

adverse drug reaction

Erythromelalgia

Intravenous Immunoglobulin

Aseptic Meningitis

Burning Pain

Erythema