IVIG Use in Specific Clinical Contexts

Established IVIG Indications

The American College of Physicians recommends IVIG 0.4 g/kg/day for 5 days (total 2 g/kg) or plasmapheresis for Guillain-Barré syndrome (Grade 3-4) 1, 2
The American Academy of Neurology recommends IVIG 2 g/kg IV over 5 days for Myasthenia gravis (Grade 3-4) 1
The American College of Rheumatology recommends IVIG at 2 gm/kg as adjunctive therapy only for Refractory GPA/MPA vasculitis 3, 4
The British Association of Dermatologists recommends IVIG 2 g/kg divided over several days for refractory Pemphigus vulgaris 5
The American Society of Hematology recommends IVIG 1 g/kg as one-time dose with corticosteroids for Immune thrombocytopenia 6
The American Academy of Allergy, Asthma, and Immunology recommends IVIG for antibody deficiency disorders causing recurrent sinusitis, but requires documented impaired antibody production, significant infectious morbidity, and failure of aggressive antimicrobial/surgical therapy 7, 8

None of the provided guidelines (ASCO, ACR, ASH, AAAAI) address PANDAS/PANS as an indication for IVIG 1, 2, 3, 4, 5, 6, 7, 8
The patient's case does not demonstrate the severe, documented immunodeficiency required for IVIG approval, such as recurrent pneumonias or documented bacterial infections beyond the neuropsychiatric symptoms 7, 8
The criteria document notes "UNKNOWN" for documented objective assessment using standardized scales (CY-BOCS, PANS, PANDAS scales), which are essential for establishing medical necessity and monitoring response 7