On hospital day 2, his BP had returned to baseline, with spontaneous diuresis and resolution of edema, and he was discharged the next day

On hospital day 2, his BP had returned to baseline, with spontaneous diuresis and resolution of edema, and he was discharged the next day. Two weeks later, the day before his next scheduled IVIG infusion, he awoke feeling weak, diaphoretic, and fatigued. with mortality because of compartment syndromes and rhabdomyolysis (1). IV immunoglobulin (IVIG) has typically HSP27 inhibitor J2 been given during the later stages of the episode as a rescue therapy, HSP27 inhibitor J2 if at all (3). Although Lambert et al. reported in 2008 that IVIG administered at or near the onset of flares resulted in rapid symptom resolution in 3 patients (4), this approach has not been widely embraced (1, 2). In a recent cohort study (1), acute IVIG therapy was not linked to increased survival and was suggested to be contraindicated during acute flares because of potential nephrotoxicity (1). Here, we report the utility of IVIG as initial therapy for ISCLS episodes in lieu of IV fluid resuscitation. Methods Patients were enrolled in a National Institutes of Health protocol (09-I-0184) approved by the HSP27 inhibitor J2 National Institutes of Health institutional review board. The patients provided informed consent before enrollment and consented to publication of this article. Case Series The clinical course and laboratory abnormalities in 6 patients treated with IVIG at or near the onset of idiopathic systemic capillary leak syndrome (ISCLS) episodes are summarized in Tables 1 and ?and22. Table 1. Patient Demographics and Hospital Course

Parameter Patient 1 Patient 1 Patient 2 Patient 2 Patient 2 Patient 3 Patient 4 Patient 5 Patient 6 Episode 1 Episode 2 Episode 1 Episode 2 Episode 3

Age, y*707255555568444961SexMaleMaleMaleMaleMaleMaleRaceWhiteWhiteWhiteAfrican AmericanWhiteWhiteMGUSIgGIgGIgGIgGIgGIgGTriggerInfluenza ACOVID-19UnknownUnknownUnknownCOVID-19COVID-19UnknownUnknownPresenting signs and symptomsInfluenza-like symptoms, diaphoresis, near-syncopeURI symptoms, hypotension, and tachycardiaMyalgias, fatigue, lightheadedness, and palpitationsFatigue, myalgias, lower extremity edema, oliguria, hypotensionWeakness, fatigue, diaphoresisFatigue, URI symptoms, oliguria, exertional dyspneaFatigue, myalgias, abdominal distention, near-syncopeInfluenza-like symptoms, upper extremity edema, hypotension, and tachycardiaWeakness, myalgias, peripheral edemaComplicationsRight forearm edema without compartment syndromeBilateral thigh edema without compartment syndromeNoneNoneNoneNoneNoneNoneNoneTreatmentsIVIG (2 g/kg of body weight), IV fluids (<500 mL crystalloid)?, oseltamivir, prednisoneIVIG (2 g/kg of body weight), prednisoneIVIG Rabbit Polyclonal to Patched 1 g/kg/body weightIVIG (1 g/kg of body weight)IVIG (1 g/kg of body weight)IVIG (1 g/kg of body weight), prednisoneIVIG (2 g/kg of body weight), remdesivirIV fluids?, IVIG (1 g/kg of body weight)IVIG (0.5 g/kg/day for 4 days)OutcomeDischarged on hospital day 3Discharged on hospital day 3Outpatient, discharged homeDischarged on hospital day 3Discharged on hospital day 3Discharged on hospital day 2Discharged on hospital day 3Discharged on hospital day 11Discharged on hospital day 4 Open in a separate window Ig = immunoglobulin; IV = intravenous; IVIG = intravenous immunoglobulin; MGUS = monoclonal gammopathy of undetermined significance; URI = upper respiratory infection. *At time of acute episode. ?Isotonic saline. 100 mg orally, 1-time dose. ?Isotonic saline, albumin. Table 2. Laboratory Abnormalities During Hospitalization

Variable Normal range* Patient 1 Patient 2 Patient 3 Patient 4 Patient 5 Patient 6 Episode 1 Episode 2 Episode 1 Episode 2 Episode 3

Peak hemoglobin level, mmol/L6.95C9.7412.110.9212.2911.0511.9811.6711.2311.0515.14Post-IVIG hemoglobin level, mmom/L?6.95C9.749.628.81ND7.457.519.378.698.328.07Nadir albumin level, g/L35C522229ND262633261625Post-IVIG albumin level, g/L?35C5226NDNDNDND28.63032.829Peak HSP27 inhibitor J2 creatinine level, mol/L48.63C106.1151.2122.9ND87.54114.9592.84119.37141.47193.64Post-IVIG creatinine level, mol/L?48.63C106.1135.28111.41ND84.8883.1161.89114.0679.5885.77 Open in a separate window IVIG = intravenous immunoglobulin; ND = not.