[PAGID] intraventricular IVIG

[Richard Wasserman]

I believe the most useful experience is

Rev Infect Dis.<javascript:AL_get(this,%20'jour',%20'Rev%20Infect%20Dis.');>
1987
Mar-Apr;9(2):334-56.
Chronic enteroviral meningoencephalitis in agammaglobulinemic patients.

McKinney RE Jr<http://www.ncbi.nlm.nih.gov/pubmed?term=%22McKinney%20RE%20Jr%22%5BAuthor%5D>
, Katz SL<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Katz%20SL%22%5BAuthor%5D>
, Wilfert CM<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Wilfert%20CM%22%5BAuthor%5D>
.
Abstract

Patients with agammaglobulinemia are particularly susceptible to chronic
enteroviral infections of the central nervous system. Data on 42 patients
were obtained by literature review, communications with other physicians,
and personal experiences. Thirty-eight patients had congenital
immunodeficiencies, most frequently X-linked agammaglobulinemia. Most
patients who could be assessed were receiving maintenance therapy with
intramuscular gamma-globulin before their enteroviral infection. Seven
patients had not been recognized as hypogammaglobulinemic before the onset
of infection. The commonest pathogens were echoviruses (37 of 41 cases),
especially type 11 (11 cases). Thus far, four patients have had sequential
or simultaneous infections with a second enteroviral serotype. Other
features of the disease have included weakness, lethargy or coma, headaches,
hearing loss, seizures, ataxia, and paresthesias. Some patients have also
had nonneurologic manifestations of chronic enteroviral infection, including
fever, the dermatomyositis-like syndrome, edema, rashes, and hepatitis.
Treatment has consisted primarily of antibody administration, either in
intravenous immunoglobulin preparations or in immune plasma. Twelve patients
have received intraventricular immunoglobulin through reservoir devices; six
of these 12 have improved substantially, as judged by clinical criteria.


I have used intraventricular gamma globulin with an Ommaya Resevoir but have
also successful with high dose IVIG. Start with 1gram/kg per week. When you
get a response and apparent suppression of viral infection you can try to
decrease the dose.

Good luck,

Richard Wasserman

Dallas

On Tue, Sep 28, 2010 at 7:50 PM, 김예진 <yaejeankim at skku.edu> wrote:


> Dear all,

>

>

>

> I have a 20 year-old agammagloulinemia pt who came down with chronic

> enterovirus meningoencephalitis.

>

> The pt has been on multiple antibiotics, dexamethasone, and Tb medication

> already several months...in other hospital.

>

>

>

> Anybody has an advice on intraventricular IVIG?  how about antiviral agent?

> Thanks in advance

>

>

>

> YaeJean

>

> --------------------------------------------------------------------------

>

> Yae-Jean Kim, MD

>

> Assistant Professor

>

> Division of Infectious Diseases

>

> Department of Pediatrics

>

> Sungkyunkwan University School of Medicine

>

> Samsung Medical Center

>

> 50 Irwon-dong Gangnam-gu

>

> Seoul, Korea

>

> Tel)  +82-2-3410-0987

>

> Fax) +82-2-3410-0043

>

>



-- 
Richard L. Wasserman, MD, PhD
DallasAllergyImmunology
7777 Forest Lane, Suite B-332
Dallas, Texas 75230
Office (972) 566-7788
Fax (972) 566-8837
Cell (214) 697-7211
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