Borrelia burgdorferi sensu lato seroconversion after intravenous immunoglobulin treatment: a cohort study.

OBJECTIVE: IVIg consists of pooled donor immunoglobulins (IgG), possibly including anti-Borrelia burgdorferi (Bbsl) antibodies. Apparent IVIg-related Bbsl seroconversion could lead to incorrect diagnosis of Lyme borreliosis. This cohort study was designed to determine how often IVIg treatment leads to apparent Bbsl seroconversion and whether antibodies disappear post-treatment.

METHODS: Sera from chronic inflammatory demyelinating polyneuropathy (CIDP) and myositis patient were analyzed, drawn pre-treatment and 6-12 weeks after start of IVIg.. In patients with apparent seroconversion follow-up samples after treatment withdrawal were analyzed, if available. Patients treated with corticosteroids were included as controls. A two-tier protocol was used for serological testing, consisting of the C6 Lyme ELISA (Oxford Immunotec) and confirmation by IgM and IgG immunoblot (Mikrogen).

RESULTS: We included 61 patients: 51 patients were treated with IVIg and 10 with dexamethasone. Of patients treated with IVIg, 42 had CIDP (82%), all were treated with Nanogam® (Sanquin Plasma Products). Nine patients had myositis (18%) and were treated with Privigen® (CSL Behring). Anti-Bbsl IgG seroprevalence pre-treatment was 3% (2/61). Apparent seroconversion during IVIg treatment occurred in 39% of patients (20/51), all treated with Nanogam®. Post-treatment seroreversion occurred in 92% of patients (12/13) with available follow up samples; in 78% (7/9) seroreversion was observed within 3 months.

CONCLUSIONS: Transient presence of anti-Bbsl IgG antibodies after IVIg is regularly observed. This effect appears to be dependent on the IVIg brand, probably reflecting variation in Bbsl exposure of plasma donors. Lyme borreliosis serological testing during, and weeks to months after IVIg, is therefore of limited utility.