A Rare Complication After Intravenous Immunoglobulin: Diffuse Alveolar Hemorrhage.

Introduction: DAH is a clinical condition that can lead to dyspnea, hemoptysis, anemia and alveolar consolidations and cause acute respiratory failure. DAH may occur due to immune and non-immune causes, it is rare to develop as a result of IVIG treatment. Herein, a case of DAH diagnosed as a result of IVIG treatment is presented. Case: A 46-year-old male patient admitted to the emergency room with complaints of shortness of breath and cough was admitted to the intensive care unit after a positive covid test. The patient had a history of ischemic stroke and was taking acetyl salicylic acid and clopidogrel. On physical examination SpO2 : 80% and decreased breath sounds in bilateral lungs. Laboratory results showed WBC: 27 K/uL, HGB: 9 g/dL PLT: 107 K/uL, procalcitonin: 10 ug/L CRP: 175 mg/L. Thorax CT of the patient showed ground-glass density and fibrotic changes in the lower lobes of both lungs. The patient was started on piperacillin tazobactam 4x2.25 gr, moxifloxacin 1x400 mg, prednisolone 1x80 mg, enoxaparin IU/0.4 mL 1x1, pantoprazole 1x40 mg. Patient with HGB: 8 g/dL, PLT: 1 K/uL with extensive petechiae on the body by performing a peripheral blood smear hematology department was consulted and low platelets were attributed to sepsis. After 2 days of 80g IVIG, the patient’s PLT value started to increase, but hemoptysis occurred. Continuous positive airway pressure was applied to the patient who had diffuse consolidation in both lungs compatible with DAH on thorax CT. The patient who did not have hemoptysis in the follow-up, whose consolidations decreased in PAAC and whose antibiotic treatment was completed was discharged with the recommendation of outpatient clinic control. Discussion: IVIG is a plasma product widely used in the treatment of many autoimmune and systemic inflammatory diseases. However, serious side effects such as acute renal failure, myocardial infarction, stroke, deep vein thrombosis, pulmonary embolism, anaphylaxis and aseptic meningitis may occur. DAH, after IVIG has also been reported as a very rare complication. [ABSTRACT FROM AUTHOR]