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The authors report on the cases of two adult male patients presenting with autoimmune cytopenias associated with malignancies: a case of autoimmune haemolytic anemia occurring after remission of Hodgkin's disease and a case of autoimmune neutropenia in the setting of renal carcinoma. High-dose intravenous immune globulins (IIG) administered after failure of corticosteroid therapy produced a rapid and long-lasting response. These cases illustrate that intravenous immunoglobulins may be helpful in refractory cases of autoimmune cytopenias. The association of IIG and corticosteroid could be synergistic and effective independently of the outcome of the underlying disease. The pathophysiogenic mechanisms and literature are discussed briefly.

Intravenous immunoglobulin (IVIG) is currently used for an increasing number of indications where an immune-medicated disorder is suspected. It is considered as a safe and efficacious treatment but several cases of severe acute renal failure (ARF) have been described since 1987. We report four cases of IVIG-induced ARF and the literature on the subject is reviewed. The chronological and semiological characteristics of this rare adverse effect are analysed. A sudden and marked increase of serum creatinine within the 2 to 4 days following institution of IVIG therapy, especially when the patient becomes oligo-anuric, is very suggestive of IVIG renal toxicity. The recovery of renal function is often obtained in 10 to 15 days after discontinuation of the drug. Histological changes are characterized by osmotic nephrosis injuries. Patients generally presented numerous risk factors such as over 65 years, particularly in men, pre-existing renal disease, long-standing diabetes mellitus or hypertension, volume depletion, quick infusion rate, body-weight adjustment of IVIG doses in fat subjects. The mechanism of renal injury remains speculative but an oncotic overloading of kidney probably occurs. These results indicate the need for research and investigation of risk factors before starting IVIG therapy. Close monitoring of serum creatinine and diuresis should be carried out during and after treatment.