A review of the adverse effects of intravenous immunoglobulin infusion in pediatric multisystem inflammatory disease patients (MIS-C)

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Abstract Background Multisystem inflammatory syndrome in children (MIS-C) are associated with systemic inflammation and intravenous immunoglobulin (IVIG) infusion is the first-line cornerstone of therapy. We aimed to evaluate the demographic and clinical findings of children diagnosed with MIS-C, the incidence of adverse effects events of IVIG infusion, and identify the influencing factors. Methods A single-center retrospective study was designed to evaluate children hospitalized with MIS-C and receiving IVIG infusion therapy between February 2020 and February 2023. Results 108 patients diagnosed with MIS-C and receiving IVIG treatment were included in the study. When the disease severity of 98 patients diagnosed with MIS-C was evaluated, 50 (51.0%) patients were found to have mild MIS-C, 25 (25.5%) patients had moderate MIS-C, and 23 (23.5%) patients had severe MIS-C. Twenty-five patients (23.2%) required pediatric intensive care unit follow-up. In 38.9% (n = 42) of the patients, glucocorticoids were combined with IVIG. Fever was identified in 34.3% (n = 37) of patients when adverse effects were examined during IVIG infusion. In 27.8% of patients (n = 30), IVIG infusion had to be stopped, with the most common reasons being 83.3% fever, 10% rash, 3.3% headache, and 3.3% vascular access change. There was no statistically significant difference in IVIG infusion adverse effects or infusion-stopping frequency between patients who received and did not receive steroid treatment (p = 0.557). There was no significant difference between the severity of MIS-C and the adverse effects and infusion stopping time in individuals receiving IVIG infusion (p = 0.139). Conclusions In our study, adverse effects related to IVIG infusion were rarer and less severe than in previous reports. The most common adverse effect of IVIG infusion and the reason for discontinuation of the infusion was fever. We discovered that steroid therapy and MIS-C severity did not affect IVIG adverse effects. It was given by prolonged infusion in most patients; perhaps this is why we did not observe any serious adverse effects in children. We recommend that patients diagnosed with MIS-C and treated with IVIG should be closely monitored for adverse effects, and risk factors should be determined correctly.

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