Age: 58.0
Sex: F
Vaccine: PPV
Symptoms: Subarachnoid haemorrhage
Clinical narrative: This spontaneous report was received from a physician via a medical records referring to a female patient of unknown age. In 2009 and in 2016, the patient was vaccinated with a dose of PNEUMOVAX 23 (strength, dose number, route, frequency, lot number and expiration date were not reported) for prophylaxis. Other suspect therapies included ADACEL and PREVNAR 13. Concomitant therapies included atorvastatin calcium, calcium carbonate, cyanocobalamin, levothyroxine sodium (manufacturer unknown), ubidecarenone, biotin and sulfamethoxazole, trimethoprim. On an unknown date, the patient experienced Idiopathic thrombocytopenic purpura (Immune thrombocytopenic purpura), Subarachnoid hemorrhage, knee joint replaced by other means (Arthropathy), calculus of Kidney (Nephrolithiasis), Stress incontinence ( Stress urinary incontinence), Multiple pulmonary nodules (Pulmonary mass ), gallstone (cholelithiasis), migraine, unspecified acquired hypothyroidism, unspecified hyperlipidaemia, benign essential hypertension and other health problems within the family (adverse event). On 07-APR-2016, a CT (Computerized tomography) was performed for comparison. It was reported that on 26-JAN-2017, a CT chest with and without intravenous contrast for the pulmonary nodules was performed which showed the below results: TECHNIQUE: Multi Detector transaxial images were acquired from lung apices to the base of the diaphragm before and after administration of 50 ml of VISIPAQUE intravenous. Sagittal and coronal reconstruction were also performed. FINDINGS: There was a moderate bilateral lower tube bronchiectasis, which had progressed from the study of 07-APR-2016. Mild bronchiectasis was also seen in the basilar aspect of the right upper lobe and lingula. The upper lobes were spared. There was bronchial wall thickening. No focal consolidation was identified. There was no pleural effusion or pneumothorax. There was 1.2 x 1.4 cm focus of ground glass attenuation in the sub pleural aspect of the right lung apex, anterior aspect. The inferior aspect of that ground glass focus had linear appearance. That could represent a scar. There were additional scattered ground glass foci which were likely post inflammatory. There were numerous to count lung nodules. There were more numerous and larger in size in the lower lobes and the basilar aspects of the right middle lobe and lingual. These were more numerous in the region of bronchiectasis, that raised a possibility that the nodules were likely post inflammatory in etiology, the larger nodules were measured as below: Right upper lobe, sub pleural, nodular density measuring 1.1 x 0.7cm. Right middle lobe, 2 nodules measuring 0.7x0.6 cm and 0.7 x 0.7 cm. Right lower lobe, sub pleural, nodular density measuring 1.3 x 1.1 cm. Left upper lobe peripheral nodule measuring 1.1 x 0.9 cm. Left lower lobe, peripheral nodule measuring 0.9 x 0.7 cm. No honeycombing and no debris in the central tracheobronchial tree were identified. There were enlarged mediastinal lymph nodes. The largest lymph node was seen in the sub cranial region measuring 2 x 1.1 cm. There was an enlarged lymph noted in the pre cranial region measuring 1.9 x 1 cm. There were additional borderline enlarged lymph nodes throughout the mediastinum. There were bilateral mildly enlarged hilar lymph nodes. The largest right hilar lymph node measures 1.2 x 1.7 cm. The largest left hilar lymph node measures 1.3 x 0.7 cm. No axillary lymphadenopathy was identified. The heart was non enlarged. There was no pericardial effusion and no aortic aneurysm. The visualized portions of the thyroid gland demonstrated no abnormal density. The visualized upper abdomen demonstrated calcified gallstone, unchanged. There was a right renal upper non obstructive stone measuring 4 mm, which was unchanged. There was stable small hypodensity in the left lobe of the liver, possibly a cyst. The spleen was borderline in size. IMPRESSION: 1. Moderate bilateral lower lobe bronchiectasis with bronchial thickening. 2. Too numerous to count lung nodules predominantly in the regions of bronchiectasis. 3. Mild mediastinal and bilateral biliary lymphadenopathy, likely reactive. PLAN: -Laboratory tests of Lipids, TSH free T4 for one year -CT chest -Vaccination with other doses of PNEUMOVAX 23. At the time of the report, the outcome of immune thrombocytopenic purpura, adverse event, essential hypertension, hyperlipidaemia, hypothyroidism, migraine, cholelithiasis, pulmonary mass, stress urinary incontinence, nephrolithiasis, arthropathy and subarachnoid haemorrhage was unknown. The reporter did not assess the relatedness between all aforementioned events and the suspect therapies. Upon internal review, immune thrombocytopenic purpura, subarachnoid haemorrhage, arthropathy and nephrolithiasis were considered to be a medically significant. All available medical records will be provided upon request. Additional information has been requested.