Aseptic meningitis due to administration of intravenous immunoglobulin with an unusually high number of leukocytes in cerebrospinal fluid

Neurologic adverse reactions have been reported in up to 34% children who are treated with intravenous immunoglobulin (IVIG) (1). Reactions are generally mild and transient, but a small number of patients develop aseptic meningitis (AM). Clinical and cerebrospinal fluid (CSF) characteristics may be indistinguishable from those found in patients with bacterial meningitis, which constitutes in some instances a diagnostic and patient management challenge in the emergency department setting (2). We describe two patients with immune thrombocytopenic purpura (ITP) who developed AM subsequent to the infusion of IVIG. One of them presented with an unusually high number of leukocytes in CSF. We also review previously reported pediatric cases of IVIG-associated AM.