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Final Program


Final Program

Stroke

1422 - IVIG and Embolism: Cerebrovascular Accident Following Immunotherapy

Friday, February 20, 2026
5:00 PM - 6:30 PM AST
Case Diagnosis: Embolic stroke following intravenous immunoglobulin (IVIG) administration in a renal transplant recipient with suspected vasculitic neuropathy

Case Description: A 67-year-old right-handed female with end-stage renal disease due to polycystic kidney disease, status post renal transplant, hypertension, and hypothyroidism presented initially for failure to thrive and underwent cholecystectomy for biliary dyskinesia. During inpatient rehabilitation, she developed right-sided hemiparesis and facial droop. MRI revealed a subacute left basal ganglia infarct. Stroke workup including transesophageal echocardiogram, magnetic resonance angiography, and bubble study was unremarkable. Dual antiplatelet therapy was initiated. EMG showed sensorimotor polyneuropathy and chronic radiculopathy. Given suspicion for vasculitic neuropathy, she received a single dose of IVIG. Days later, she developed binocular diplopia and left eye deviation. Repeat MRI revealed new infarcts in the corpus callosum and left postcentral gyrus. IVIG was discontinued, and high-dose steroids were administered. Vessel wall imaging suggested intracranial atherosclerotic disease. An implantable loop recorder was later placed. She was eventually able to return to rehabilitation with gradual functional improvement. 

Discussions: This case highlights a rare but serious thrombotic complication potentially related to IVIG therapy in a medically complex transplant patient. While IVIG is commonly used for immune-mediated neuropathies, it carries a risk of inducing thromboembolic events, particularly in patients with predisposing factors. The diagnostic challenge was made challenging in the setting of multifocal strokes in the context of suspected vasculitis and immunosuppression.  

Conclusions: Clinicians should remain vigilant for thrombotic complications following IVIG, especially in transplant recipients or patients with suspected vasculitic processes. Early recognition and intervention are critical to improve outcomes and guide rehabilitation planning.