Sex: F
Vaccine: FLUX
Symptoms: Pulmonary function test abnormal, Rash vesicular, Toxic epidermal necrolysis
Clinical narrative: This serious literature case, initially received on 23-Jul-2018, reported by other health professional and concerns a 31-year-old, adult, female patient. It was reported that, the patient had no pulmonary diagnosis or complaints. On an unspecified date, the patient was administered with influenza vaccine (dose, route of administration, anatomical location, batch number, expiry date, trade name, manufacturer: not reported). On an unspecified date after vaccination, the patient experienced blistery rash on face, neck, chest, back, abdomen, arms, lips, anus, and genitals and was admitted to intensive care unit. On an unspecified date, skin biopsy was performed, in which toxic epidermal necrolysis (TEN) was diagnosed. The patient required endotracheal intubation and mechanical ventilator support. The patient was successfully extubated after 14 days. On an unspecified date, flexible bronchoscopy was performed, in which no abnormalities were found. The patient was discharged from the hospital without requiring supplemental oxygen. On an unspecified date, 5 months after an episode of TEN, the patient was presented to primary care unit with progressive dyspnoea on exertion and non-productive cough. On an unspecified date, pulmonary function tests (PFT) was performed, in which forced expiratory volume (FEV1)/forced vital capacity (FVC) showed 85 percent with FEV1 0.79L (39 percent) and no bronchodilator response. The patient was prescribed with albuterol inhaler and there was no improvement in her symptoms. Hence the patient was referred for a pulmonary evaluation. On an unspecified date, PFT test was performed again, which showed persistent non-reversible airflow obstruction. High resolution computed tomography (HRCT) of the chest was performed, which showed multifocal ground glass densities, multilobar bronchiectasis, and air trapping without tracheomalacia. It was reported that, the patient did not desaturate on six-minute walk test. The patient was treated with prednisone (orally) for the treatment of obliterative bronchitis (OB). The patient had not recovered from the event airflow obstruction and was recovering from the event dyspnoea exertional. The outcome of the other events was not reported. Reporter stated that, pulmonary complications arising from Toxic epidermal necrolysis (TEN) often manifest in the acute setting. The patient had developed respiratory complaints 5 months post TEN. Pulmonary complications in the chronic phase of TEN are rare and most of the them are secondary to obliterative bronchiolitis. Pulmonary function tests (PFTs) reveal no reversible airflow obstruction and High-resolution computed tomography (HRCT) demonstrated bronchiectasis, thickened bronchial walls, and signs of air trapping. No effective therapy has been determined for the treatment of obliterative bronchitis (OB) after TEN and lung transplant referral is often required. This condition is associated with significant disease burden. Early awareness and referral to lung transplant is essential until future therapies are discovered. Imaging: High resolution compute tomography demonstrating bilateral central bronchiectasis. The reporter considered the event toxic epidermal necrolysis as related to flu vaccine.