Transfusion-related acute lung injury (TRALI) following intravenous immunoglobulin infusion in a patient with myasthenia gravis

ABSTRACT

Transfusion-related acute lung injury (TRALI) is a rare but potentially life-threatening complication of blood product administration and has been infrequently associated with intravenous immunoglobulin (IVIG) therapy. This case report describes an 82-year-old male with myasthenia gravis who developed acute respiratory distress approximately 30 minutes after initiating high-dose IVIG. His clinical presentation included severe hypoxemia, hypotension, fever, and bilateral pulmonary infiltrates on chest imaging. Bedside ultrasound showed a collapsible inferior vena cava and normal cardiac function, supporting a non-cardiogenic etiology. The patient had no recent transfusions, pulmonary disease, or other acute lung injury risk factors. Infectious, allergic, and cardiogenic causes were excluded, and the diagnosis of TRALI was established based on established clinical criteria. The IVIG infusion was immediately stopped, and the patient required mechanical ventilation. Plasmapheresis was initiated for the underlying myasthenic crisis, and the patient showed rapid clinical improvement, with successful extubation after the second session and discharge on immunosuppressive therapy. This case underscores TRALI as a rare but serious adverse event following IVIG administration. Timely recognition using clinical and imaging criteria, along with prompt supportive care, is essential. Greater awareness is needed to improve diagnosis and reporting of this underrecognized complication, particularly in neurologic patients receiving high-dose IVIG.

Keywords: TRALI, IVIG, myasthenia gravis