Sex: F
Vaccine: FLUX
Symptoms: Angiogram, Areflexia, CSF culture, Chest pain, Computerised tomogram normal
Clinical narrative: transverse myelitis; urinary retention; Flu-like symptoms; Spinal Artery Infarction; Numbness in leg; leg weakness; thoracic chest pain; absent reflexes; hyper-reflexic; overdose; This case was reported in a literature article and described the occurrence of myelitis transverse in a adult female patient who received Flu unspecified (Influenza vaccine) for prophylaxis.   Co-suspect products included naratriptan hydrochloride (Naratriptan) unknown (batch number UNK, expiry date unknown) for migraine.   Concurrent medical conditions included chronic migraine (sever without aura was taking Naratriptan 2.5 mg).   On an unknown date, the patient received Influenza vaccine and Naratriptan 2.5 mg twice daily (5 mg daily). On an unknown date, 2 weeks after receiving Influenza vaccine and less than a day after starting Naratriptan, the patient experienced myelitis transverse (serious criteria GSK medically significant), urinary retention (serious criteria GSK medically significant), influenza-like symptoms, spinal disorder, numbness in leg, lower extremities weakness of, chest pain, absent reflex, hyperreflexia and overdose. The patient was treated with methylprednisolone. The action taken with Naratriptan was unknown. On an unknown date, the outcome of the myelitis transverse, urinary retention, influenza-like symptoms, spinal disorder, numbness in leg, lower extremities weakness of, chest pain, absent reflex and hyperreflexia were recovered/resolved and the outcome of the overdose was unknown.   It was unknown if the reporter considered the myelitis transverse, urinary retention, influenza-like symptoms, spinal disorder, numbness in leg, lower extremities weakness of, chest pain, absent reflex and hyperreflexia to be related to Influenza vaccine. It was unknown if the reporter considered the myelitis transverse, urinary retention and influenza-like symptoms to be related to Naratriptan. The reporter considered the spinal disorder, numbness in leg, lower extremities weakness of, chest pain, absent reflex and hyperreflexia to be related to Naratriptan.  Additional details were provided as follows: This case was reported in a literature article and described the occurrence of Flu-like symptoms; Naratriptan-Associated Spinal Artery Infarction, in a female patient of unspecified age (in her 40s), who was vaccinated with Unspecified flu vaccine (manufacturer unknown) for prophylaxis.   The patient was in her forties with history of chronic migraine without aura was taking Naratriptan 2.5 mg as needed for her migraines. The patient had no vascular risk factors, medical comorbidities. No information on patient family history or concurrent condition or concomitant medication was reported.  On an unknown date, the patient received unspecified Flu vaccine (administration site or route unspecified, dose not reported, batch number not provided). The age at vaccination was not reported. On an unknown date, 2 weeks after vaccination, the patient presented with flu-like symptoms. On the day of symptom onset, the patient took twice the amount of her prescribed Naratriptan dosage for severe migraine and after 2 hours with still no relief, the patient then took another 2.5 mg. Later that day, the patient developed numbness in her legs followed by severe leg weakness, urinary retention and thoracic chest pain. The patient examination showed flaccid lower extremities and a T4 sensory level with initially absent reflexes, which later became hyper-reflexic. Magnetic resonance imaging (MRI) scans showed T3 to T6 spinal infarction with restricted diffusion on diffusion-weighted imaging and T2 hyperintensity within the anterior spinal artery distribution. Echocardiogram did not show event of patent foramen ovale (PFO). The patient spinal fluid analysis was normal and rest of the neural axis imaging was negative for abnormal lesions. The patient was given 5 days of intravenous (IV) methylprednisolone 1 g daily for the possibility of transverse myelitis with no response. An extensive inflammatory and vascular evaluation, including computed tomography angiogram of the chest and abdomen was negative for dissection, vascular abnormalities, or inflammation. The patient had slow but good recovery and was maintained off tripants and did not have any subsequent neurological attacks over next 4 years. The authors commented "we describe a case of spinal infarction in the setting of naratriptan overuse, an adverse event not previously described in literature".