Abstract
BackgroundAlthough influenza vaccines are generally safe and effective, a variety of autoimmune phenomena have been reported after vaccination over the past years, such as Guillain–Barre syndrome, rheumatoid arthritis, pemphigus vulgaris, psoriasis, giant cell arteritis and anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV).Case reportWe describe the case of a 67-year old man who presented with a myeloperoxidase-ANCA associated vasculitis with renal involvement and mononeuritis multiplex after seasonal influenza vaccination. He was initially treated with intravenous cyclophosphamide and high-dose prednisolone followed by maintenance treatment consisting of azathioprine and prednisolone.ConclusionWe hypothesize that seasonal influenza vaccination triggered a systemic immune response in a susceptible patient to develop AAV with renal involvement and vasculitic neuropathy. In general, seasonal influenza vaccinations are considered to be safe, however, clinicians should be aware of this rare phenomenon.
Highlights
Influenza vaccines are generally safe and effective, a variety of autoimmune phenomena have been reported after vaccination over the past years, such as Guillain–Barre syndrome, rheumatoid arthritis, pemphigus vulgaris, psoriasis, Henoch–Schönlein purpura, polymyalgia rheumatic, giant cell arteritis and anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) [1,2,3,4,5]
The progressive neurological impairment was highly suggestive of mononeuritis multiplex, especially in combination with the results of the performed EMG as well as the histopathological proven renal vasculitis [22]
In this report we described another case suggesting a temporal relationship between influenza vaccination and AAV with mononeuritis multiplex
Summary
Influenza vaccines are generally safe and effective, a variety of autoimmune phenomena have been reported after vaccination over the past years, such as Guillain–Barre syndrome, rheumatoid arthritis, pemphigus vulgaris, psoriasis, giant cell arteritis and anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV ).Case report: We describe the case of a 67-year old man who presented with a myeloperoxidase-ANCA associated vasculitis with renal involvement and mononeuritis multiplex after seasonal influenza vaccination. *Correspondence: s.eindhoven@gmail.com 6 Department of Internal Medicine, Room F104, IJsselland Hospital, P.O. Box 690, 2900 AR Capelle aan den IJssel, The Netherlands Full list of author information is available at the end of the article with a peak incidence of only 65 per million/year in those aged 65–74 years [6, 7]. We describe a case of a patient presenting with AAV after influenza seasonal vaccination. Over the past 3 years he received influenza vaccinations twice without any complications.
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