Sex: M
Vaccine: FLUX
Symptoms: Erythema multiforme, Herpes simplex test negative, Immunoglobulin therapy, Immunology test normal, Influenza
Clinical narrative: Initial unsolicited report received from the literature on 04-Jan-2018. The following is verbatim from the article: Abstract A 2-year-old boy with influenza B infection and rapidly worsening targetoid skin lesions with mucosal involvement was diagnosed with Stevens-Johnson syndrome (SJS) and treated with oseltamivir and intravenous immunoglobulin, with resolution of illness. Subsequent quadrivalent inactivated influenza vaccine was well tolerated. This case highlights the rarity of SJS in the setting of influenza B infection and addresses the safety of administering subsequent influenza vaccines to such individuals. This case involves a 24-months-old male patient who was vaccinated with a dose of TRIVALENT INACTIVATED INFLUENZA VACCINE (Batch number, expiration date, dose, dose in series, route and site of administration were not reported) on an unspecified date (also reported as three months before presentation in the hospital). The patient was previously healthy. Other medical history was not reported. Concomitant medications were not reported. On an unknown date, after the vaccination, the patient experienced fever, congestion, rhinorrhea, myalgia and a progressive pruritic facial eruption. So on an unknown date in the winter of 2013, the patient presented in the hospital with a 5-day history of above mentioned events and was hospitalized. On an unknown date (also reported as two days before presentation in the hospital), his pediatrician had started DEXAMETHASONE, IBUPROFEN, FAMOTIDINE, and DIPHENHYDRAMINE because of suspicion of an allergic skin eruption, there were no known medication exposures, including acetaminophen or ibuprofen, preceding the appearance of skin lesions, It was reported that over the next 2 days, skin lesions became widespread, prompting reevaluation, also vital signs were significant for fever 101 degree Fahrenheit, tachycardia, and tachypnea with normal blood pressure and skin examination revealed pink, annular, edematous papules and plaques on the face, trunk, buttocks, and extremities, many with dusky, violaceous centers Multiple tense vesicles and targetoid erythematous papules were located perianally, rare serous vesicles were noted centrally, with negative Nikolsky and Asboe-Hansen signs, there was no skin tenderness. Additional findings included cervical lymphadenopathy, mildly injected sclera, and dry crusted lips. There was no genital or palmoplantar involvement. The remainder of the physical examination was unremarkable. Laboratory evaluation revealed White Blood Cells (leukocytosis) (17 x 109/L) and high C-reactive protein (10 mg/L). Empiric therapy with AZITHROMYCIN, ACICLOVIR, and CLINDAMYCIN was initiated while serologic titers and cultures (urine, skin, and blood) were pending. Because of continued fever, PIPERACILLIN/TAZOBACTAM was added on hospital day 2. A nasopharyngeal swab was positive for influenza B and negative for mycoplasma and 18 other common respiratory pathogens according to a respiratory viral polymerase chain reaction (PCR) panel. OSELTAMIVIR therapy was initiated and supportive care provided. Skin biopsy revealed necrotic keratinocytes within the epidermis and an interface dermatitis consistent with the erythema multiforme/Stevens-Johnson syndrome (EM/SJS) spectrum of inflammatory dermatoses. Immunofluorescence studies were negative for immunobullous disease. Antistreptolysin O (ASO), mycoplasma, parvovirus, herpes simplex virus (HSV), Epstein-Barr virus (EBV), and cytomegalovirus titers; surface bacterial and viral cultures; blood culture; and urine culture were negative, and acyclovir and antibiotics were subsequently discontinued. Despite supportive therapy, the patient's eruption rapidly progressed to involve more than 10 percentage of his body surface area, with skin fragility and denudation requiring transfer to intensive care. Wound care and fluid management continued, and given the progression of cutaneous disease, intravenous IMMUNOGLOBULIN (IVIg) 1 g/kg/d was administered for 3 days, resulting in defervescence and skin stabilization. His lesions reepithelialized and on an unknown date in 2013, on hospital day 7, he was discharged from the hospital. On an unknown date, after the vaccination (also reported as three months after hospital discharge), the patient developed minimal postinflammatory hypopigmentation. It was also a case of vaccination failure. It was reported that the patient was previously vaccinated for influenza at 9, 12, and 23 months of age without incident. It was also reported that during the following influenza season, after discussion with vaccine safety experts, the child received an inactivated quadrivalent influenza vaccine containing both influenza B lineages with close monitoring. He tolerated the vaccine well, without any reported adverse reaction after vaccination. Other laboratory investigations and other corrective treatment were not reported. On an unknown date, the patient recovered from influenza B virus infection, myalgia, rhinorrhea, Stevens-Johnson syndrome, erythema multiforme, fever, facial eruption, pruritus, widespread skin lesions, Skin plaque, papule, vesicles, cervical lymphadenopathy, dry crusted lips, tachycardia, tachypnea and condition aggravated (reported as the patient was well) but the outcome of minimal postinflammatory hypopigmentation was not reported. Upon internal review the event was considered as serious because of important medical event: vaccination failure. List of documents held by sender: none. Sender's Comments: Time to onset was compatible. medical history along with condition at the time of vaccination was not reported. Vaccine name and lot number was also not reported. Events are suggestive of a possible allegic response. Additional information regarding medical histiry, allergic reactions experienced in past if any should be requested. Influenza infection was diagnosed by PCR teating therefore this was also a case of vaccination failure. Additional information regarding product name or lot number should be requested. It was reported that household contact had experienced flu symptoms before current symptom onset. This could be a case of aquuired infection via contact. Based upon reported information the role fo the vaccine can not be assessed.