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DAVID A. WHITE, B.SC., B.PHARM., is Restricted Drug Pharmacist, Drug Information Center, Department of Pharmacy; and MANDY C. LEONARD, PHARM.D., BCPS, is Assistant Director, Drug Information Services and Formulary Management, Department of Pharmacy, The Cleveland Clinic Foundation, Cleveland, OH.

Address correspondence to Mr. White at the Department of Pharmacy, Hb03, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195-5245 (whited1{at}ccf.org).

Purpose. A case of acute stroke in a patient who was receiving high-dose intravenous immune globulin (IVIG) for dermatomyositis is reported. Summary. A 43-year-old woman presented with overwhelming proximal weakness and myalgias, swelling in her hands, facial and knee rash, generalized fatigue, numbness in her left arm, and lower-back pain. Physical examination revealed that she had symptoms consistent with dermatomyositis. The patient was initially treated with prednisone but developed a severe adverse drug reaction to the medication. The prednisone was discontinued, and the patient was admitted to the hospital for a first-time dose of IVIG therapy. During the infusion, the patient was found to have a facial droop, left-sided hemiplegia, and an increase in restlessness. A large, significant right internal carotid artery occlusion was discovered and initially treated mechanically and then with drugs in an attempt to establish revascularization. A subsequent computed tomography scan of the brain demonstrated a large rightmiddle cerebral distribution infarct with slight hemorrhage into the basal ganglia. IVIG is increasingly being used for many approved and nonapproved indications. Although rare, stroke associated with thrombosis caused by the administration of IVIG has been reported in the literature. On the basis of the Naranjo probability scale, this adverse drug event was calculated as a probable reaction due to the administration of IVIG. Conclusion. A patient had an acute stroke after receiving a high dose of IVIG for dermatomyositis. Patients should be given a slower rate of infusion and smaller dosages of IVIG, and they should be closely monitored for potential stroke associated with thrombosis during IVIG therapy. Index terms: Cerebrovascular accident; Dermatomyositis; Dosage; Drug administration rate; Globulin immune; Injections; Serums; Toxicity