Immunoglobulin-Induced Aseptic Meningitis in Juvenile Dermatomyositis: A Case Report

Abstract

Aseptic meningitis is a known but unusual serious adverse effect of intravenous immunoglobulin (IVIG). It usually resembles infectious meningitis, which makes its diagnosis challenging. In this report, we present the case of a five-and-a-half-year-old Chinese girl with juvenile dermatomyositis (JDM) who presented with signs of meningismus 21 hours after the initiation of IVIG infusion. Her blood work at diagnosis showed neutrophilia and lymphopenia. The cerebrospinal fluid (CSF) analysis demonstrated neutrophilic pleocytosis, hyperproteinorrachia, and normoglycorrhachia. All microbiological tests were negative. The child fully recovered within 72 hours without neurological sequelae. IVIG-induced aseptic meningitis remains a diagnosis of exclusion. Although it is rare, pediatricians should be aware of this complication and avoid unnecessary investigations or treatment.

Keywords: drug-induced aseptic meningitis; intravenous immunoglobulin (ivig); juvenile dermatomysitis; pediatric rheumatology; young child.

Figure 1. Childhood Myositis Assessment Scale (CMAS) scoring sheet

1. Lovell DJ, Lindsley CB, Rennebohm RM, et al.: Development of validated disease activity and damage indices for the juvenile idiopathic inflammatory myopathies. II. The Childhood Myositis Assessment Scale (CMAS): a quantitative tool for the evaluation of muscle function. The Juvenile Dermatomyositis Disease Activity Collaborative Study Group. Arthritis Rheum. 1999, 42:2213-2219. 10.1002/1529-0131(199910)42:10<2213::Aid-anr25>3.0.Co;2-8 2. Huber AM, Feldman BM, Rennebohm RM, et al.: Validation and clinical significance of the Childhood Myositis Assessment Scale for assessment of muscle function in the juvenile idiopathic inflammatory myopathies. Arthritis Rheum. 2004, 50:1595-1603. 10.1002/art.20179