Age: 45.0
Sex: F
Vaccine: FLUX
Symptoms: Periorbital oedema, Protein urine present, Proteinuria, Urine abnormality
Clinical narrative: Relapse of MCD; frothy urine; periorbital edema; 24 hour proteinuria  was 1.5 gram; Initial information was received on 24-Dec-2020 regarding an unsolicited valid serious case from the other healthcare professional issued from a literature article.   This case involved a 45-year-old female patient who had relapse of MCD (Minimal Change Disease) (glomerulonephritis minimal lesion) with frothy urine (urine abnormality), periorbital edema (periorbital oedema) and her 24 hour protein urine was 1.5 gram (proteinuria), after she received INFLUENZA VACCINE.  The patient's medical history included abrupt onset of bilateral hand, facial, lower extremity edema and frothy urine and she was diagnosed with MCD after kidney biopsy on an unknown date of Dec-2014 (ongoing).   Urinalysis (UA) showed 3+ protein and urine protein to creatinine (UPCR) was 6.5.  Serum albumin was 1.5 g/dL (grams per deciliter), total cholesterol 465 mg/ dL, WBC (white blood cell) 6.79 K/mm (1000 per millimeter), hemoglobin (Hgb) 14.5 g/dL, platelets 417 K/mm, BUN (blood urea nitrogen) 20 mg/ dL, creatinine 1.0 mg/dL, AST (Aspartate Aminotransferase ) 29 iU/L (International units per liter), ALT (Alanine Transaminase) 20 iU/L, C3 (complement component 3) 155 mg/dL and C4 29.3mg/dL. RPR (Rapid Plasma Reagin), hepatitis B & C serologies, and ANA (Antinuclear Antibody) were negative. After approximately 2 weeks, UPCR worsened to 12 g/g.  The patient's past medical treatment included oral prednisone 1mg/kg (milligram per kilogram) daily, torsemide with 5mg/day and rosuvastatin with 5mg/day for MCD.  Complete remission of proteinuria was documented 2 weeks later and persisted after completing a 6-month course of prednisone.  The patient had no other significant medical or allergy history and no signs of systemic infection. She was normotensive and she denied recent infections or use of NSAID (Nonsteroidal anti-inflammatory drugs).  The patient's past vaccination(s), family history and concomitant medication were not reported.  The patient remained in complete remission until Oct-2016.  On an unknown date of Oct-2016, the patient received a dose of suspect INFLUENZA VACCINE produced by unknown manufacturer (batch number and other dosing details were not reported) for prophylactic vaccination.  On an unknown date of 2016, the patient experienced serious relapse of MCD in the absence of other potential triggers of MCD(glomerulonephritis minimal lesion) with frothy urine (urine abnormality), periorbital edema (periorbital oedema) and her 24-hour protein urine was 1.5 gram (proteinuria), just after administration of INFLUENZA VACCINE. These events were assessed as medically significant.  The patients renal and hepatic chemistries were normal with creatinine 0.7 mg/dL except for serum albumin of 3.0 g/dL. UA showed protein 100 mg/dL.  The patient was treated with oral Prednisone 50mg/day from an unknown date of 2016.  The patient had recovered from proteinuria within 21 days after treatment with Prednisone and at the time of reporting, outcome was not reported for other events.   It was reported that, this case as well as previous anecdotal reports suggested that influenza vaccination and the resulting stimulation of the immune system may cause MCD.  There will be no information available on the batch number for this case.; Sender's Comments: This case concerns 45-year-old patient who presented with relapse of glomerulonephritis minimal lesion, just after vaccination with INFLUENZA VACCINE (produced by unknown manufacturer). The time to onset is compatible. However, the patient already had same events before vaccination and information regarding past vaccination, its tolerance and concomitant medications were needed to fully assess the case. Based upon the reported information, the role the vaccine cannot be assessed.