Disclosures: Christopher Alessia, DO: No financial relationships or conflicts of interest

Case Description: 12 year old female with no significant past medical history was diagnosed with Guillain-Barre Syndrome (AIDP- variant). She was treated with IVIG for five days prior to transfer to acute inpatient rehabilitation. The patient had a normal CBC on the morning of the last day of IVIG. Routine labs were obtained the day after admission showing leukopenia. The leukopenia transitioned to neutropenia. The neutropenia self-resolved without complications or intervention.

Setting: Pediatric inpatient rehabilitation unit

Patient: 12 year old female with no past medical history presenting originally to an outside hospital with numbness and tingling in hands and feet that progressed to ascending lower extremity weakness. The patient was transferred to a pediatric inpatient rehabilitation unit after being diagnosed with AIDP and treated with five days of IVIG. Assessment/

Results: The patient had a normal CBC on the fifth day of IVIG. The patient was transferred to inpatient rehabilitation after the fifth treatment. Admission labs with WBC: 2.8 K/µL and ANC: 1100 . ANC four days later was 900. Repeat labs three days later with normalized WBC count and ANC.

Discussion: IVIG is a common treatment in patients with Guillain-Barre Syndrome. IVIG-induced neutropenia has only been identified in case series. Veys et al. described two cases of neutropenia after IVIG in a pediatric population with ITP. Tam et al. described a single case of a 31-month-old female with GBS who developed progressive neutropenia during treatment. Matsuda et al. described a case series of 16 adult patients with neuroimmunologic disorders who developed varying degrees of leukopenia/neutropenia after IVIG. In most cases, WBC abnormalities develop within four days of infusion and spontaneously resolve without infection in 7-14 days.

Conclusion: Transient neutropenia is a possible complication after IVIG. The acute inpatient rehabilitation physiatrist should be aware of this rare and often self-resolving complication of IVIG.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/transient-neutropenia-in-a-pediatric-patient-with-guillain-barre-syndrome-after-ivig-a-possible-incidental-finding-in-the-inpatient-rehabilitation-population/