Acute ST elevation myocardial infarction after intravenous immunoglobulin infusion in a young patient: a rare but probable adverse effect of immunoglobulin.

Intravenous immunoglobulin (IVIG) is used in the treatment of a variety of disorders, including autoimmune conditions. IVIG has been considered a safe medication, with minor and transient adverse effects. With the wider use of IVIG, the reported rate of adverse effects has been increased, some of them are potentially fatal cardiovascular reactions due to induction of hypercoagulable state. We report a 40-year-old female treated with IVIG for Guillain-Barre syndrome, who developed chest pain 1 hr following IVIG infusion. The symptoms were associated with ST elevation in anterior leads on electrocardiogram. This anterior wall myocardial infarction (MI) is compatible with IVIG-induced hypercoagulability and considered as a probable adverse effect of this medication. To the best of our knowledge, this is probably the first case report where a young patient developed acute MI without any cardiac risk factors after IVIG infusion.

Germ cell death and their removal during initial stages of testicular ischemia and cryptorchidism: a comparative analysis.

Germ cell death and their removal from the seminiferous epithelium are common in the affected testis in conditions of unilateral ischemia or cryptorchidism; the similarities and differences, however, have not been studied between these two conditions. The present study was designed to examine the severity of the effect on testicular germ cells during the initial stages of both ischemia and cryptorchidism, which have significant implications on the restoration of fertility following surgical repair. Complete absence of spermatids was observed following 12 hr of ischemia as compared to 7 days of cryptorchidism. Germ cell removal in either case was in the direction of lumen to basement membrane leaving only a single layer of cells by 24 hr of unilateral ischemia as compared to 15 days of cryptorchidism. Levels of intratesticular testosterone was found lower in cryptorchidism (7 days) but not in ischemia till 24 hrs. Giant cells frequently observed in cryptorchid testis were absent in the ischemic seminiferous epithelium. There was a gradual increase in the number of apoptotic and non-viable cells; the latter was more than 95% by 24 hr of ischemia. In contrast, approximately 85% testicular cells were nonviable till 15 days of cryptorchidism. The 1c peak representing the population of haploid cells was significantly reduced in cryptorchidism (7 days), while the peak was completely abolished by 24 hr of ischemia. Rise in the levels of oxidative stress in the affected testis was observed identically during the initial stages. These findings indicate that coupled with the rise in tissue oxidative stress, the number of apoptotic/nonviable germ cells was alarmingly high (> 80%) by 15 days of cryptochidism or 24 hr of ischemia. Restoration of complete spermatogenesis following surgical repair may not be possible in such cases because of these acute adverse effects.