Infectious complications represent a major cause of morbidity and mortality in patients with
chronic lymphocytic leukemia (CLL). The etiology is postulated to be secondary to aberrations in cell-mediated immunity, as well as to
therapy-related immunosuppression.
Hypogammaglobulinemia, which occurs in virtually all patients with CLL, may be profound and correlates with disease duration and stage.
Intravenous immunoglobulin (
IVIG)
therapy has been used successfully to prevent and treat
infections in this cohort of patients. However
IVIG administration and treatment is not benign and should be used with caution given the potential manifestations of thromboembolic complications. High concentration and rapid infusion rate of the
IVIG, as well as increased dose and osmolarity of the
solution are thought to predispose to thrombotic events. Serum viscosity is the implicated mechanism for compromised blood flow and predisposition of high-risk patients to cardiovascular or cerebrovascular
infarction. We report a case of
IVIG related thromboembolic manifestations in a CLL patient, to highlight the importance of risk stratifying patients prior to treatment administration.
CASE PRESENTATION: We present a 55-year-old Caucasian man with CLL who presented to our clinic with neutropenic
fevers following a cycle of
chemotherapy. Laboratory parameters revealed
hypogammaglobulinemia prompting
IVIG administration. Shortly thereafter, he developed a massive cascade of thromboembolic phenomena precipitating his demise.
CONCLUSION: The current consensus surrounding
IVIG is that of a relatively safe treatment, with minor adverse effects such as
hypertension,
fever and
chills,
nausea, myalgias, or
headache. However our report highlights the importance of proceeding with caution in the application of this
therapy, as it's proclivity for thrombotic complications has not been fully elucidated in patients with underlying
malignancies. Pre-existing thrombogenic risk factors should be carefully evaluated in patients undergoing treatment with
IVIG. Clinical evaluation, with careful attention to vascular history and underlying co-morbidities can potentially unmask the high-risk patient where
IVIG could be lethal.