Age: 54.0
Sex: F
Vaccine: FLUX
Symptoms: Biopsy skin abnormal, Blister, Blood fibrinogen normal, Blood immunoglobulin A abnormal, Blood immunoglobulin G normal
Clinical narrative: This case was reported in a literature article and described the occurrence of linear IgA bullous dermatosis in a 54-year-old female subject who was vaccinated with Influenza vaccine (manufacturer unspecified). Concurrent medical conditions included depression, hyperlipidemia and osteoporosis. Concurrent medications included Alendronate, Calcium, ZOLOFT, Vit D and Rosuvastatin. The healthy subject presented at hospital with a 2-week history of a severe pruritic, vesiculobullous eruption on her legs, arms and lower abdomen that developed 2 days after she had received an influenza vaccination intramuscularly. The rash began as tiny pink papules that then formed vesicles. She continued to get new lesions despite taking Diphenylhydramine and Cetirizine as prescribed by her primary care physician. The subject had not tried topical corticosteroids or any other treatments. She denied changes in her medications, use of herbal supplements or other over-the-counter medications. The subject denied fever, chills, upper respiratory or gastrointestinal symptoms, or mucous membrane involvement. The only recent change in the subject's medications was substitution of sertraline for ZOLOFT, which had occurred 2 months prior to the eruption. Otherwise, she had been on rosuvastatin for 5 months and her other medications for over 1 year. She discontinued rosuvastatin and switched back to ZOLOFT with no improvement. The physical examination revealed symmetrically distributed discrete, pink papules, vesicles and bullae over the subject's lower extremities, hands, forearms and lower abdomen with particular concentration on the medial surfaces of her calves. She had no conjunctival injection, involvement of mucous membranes, palms or soles. This case was assessed as medically serious by GSK. Microscopic examination of a biopsy from the left calf revealed a subepidermal blistering process with neutrophils. Direct immunofluorescence revealed linear deposits of Ig A (negative IgG, IgM, C3, and fibrinogen) along with basement membrane zone. These findings in conjunction with the histology were most suggestive of linear IgA bullous dermatosis. The routine laboratory tests were normal including complete blood count and antiendomysial antibodies. The eruption cleared after 2 courses of prednisone followed by a mid-potency topical corticosteroid and did not recur when she restarted sertraline and rosuvastatin. The eruption lasted 6 weeks in total. At the time of reporting the events were resolved. The subject's medications are unlikely culprits as she had been on them for many months when the eruption began. Furthermore, the eruption resolved while she continued to take alendronate, calcium and vitamin D and did not recur when she restarted sertraline and rosuvastatin. Thus, it seems plausible that the influenza vaccination prompted development of linear IgA bullous dermatosis in this subject. Although a rechallenge with influenza vaccination followed by recur of linear IgA bullous dermatosis would provide stronger evidence for a causal relationship, the physician did not feel that it would be medically advisable for the subject to take this risk, and the subject has not received further influenza vaccinations. The author considered the events were possibly related to vaccination with Influenza vaccine.