Age: 54.0
Sex: M
Vaccine: FLUX
Symptoms: Induration, Lactic acidosis, Leukocytosis, Pyrexia, Red blood cell sedimentation rate increased
Clinical narrative: This case was reported in a literature article and described the occurrence of scleredema in a 54-year-old male patient who received unspecified Influenza vaccine for prophylaxis. Concurrent medical conditions included hypertension, type ii diabetes mellitus, morbid obesity (body mass index of 44?kg/m2) and depression. Concomitant products included Metformin and Insulin. On an unknown date, the patient received unspecified influenza vaccine at an unknown dose. On an unknown date, immediately after receiving Influenza vaccine Quadrivalent unspecified season, the patient experienced scleredema (serious criteria hospitalization and GSK medically significant), upper back pain (serious criteria hospitalization), feeling of warmth (serious criteria hospitalization), chills (serious criteria hospitalization), fever (serious criteria hospitalization), induration (serious criteria hospitalization), erythema (serious criteria hospitalization), tenderness (serious criteria hospitalization), leukocytosis (serious criteria hospitalization), tachycardia (serious criteria hospitalization), lactic acidosis (serious criteria hospitalization and GSK medically significant), sepsis (serious criteria hospitalization and GSK medically significant), cellulitis (serious criteria hospitalization and GSK medically significant), abscess (serious criteria hospitalization), skin inflammation (serious criteria hospitalization) and staphylococcus lugdunensis infection (serious criteria hospitalization and GSK medically significant). The patient was treated with Nafcillin. On an unknown date, the outcome of the scleredema, upper back pain, feeling of warmth, chills, fever, induration, erythema, tenderness, leukocytosis, tachycardia, lactic acidosis, sepsis, cellulitis, abscess, skin inflammation and staphylococcus lugdunensis infection were recovered/resolved. It was unknown if the reporter considered the scleredema, upper back pain, feeling of warmth, chills, fever, induration, erythema, tenderness, leukocytosis, tachycardia, lactic acidosis, sepsis, cellulitis, abscess, skin inflammation and staphylococcus lugdunensis infection to be related to unspecified Influenza vaccine. This case has been considered as serious due to hospitalisation. The authors did not comment on the relationship between scleredema diabeticorum and unspecified flu vaccine. The authors stated Three variants of scleredema have been described based on their association with streptococcal infection, monoclonal gammopathy, or diabetes mellitus. Our patient, however, had negative ASO titer with normal SPEP, and the findings were consistent with scleredema diabeticorum'. The authors concluded, "Scleredema diabeticorum is a rare and frequently unrecognized manifestation of diabetes. It is mostly seen in patients with poor glycemic control. Physicians need to be aware of this entity for early recognition and prevention of complications like a restrictive pulmonary defect." The article corresponding to this case is not available for submission due to copyright restriction. Lab Comments: Lab tests were performed on an unspecified date. His physical examination was significant for an extensive area of induration in the right upper back extending into the back of the neck, measured about 25?cm × 20?cm in size, and had a 3?cm × 4?cm × 3?cm area of fluctuation with erythema and tenderness. Serum protein electrophoresis (SPEP) showed a normal pattern with no monoclonal protein, and antistreptolysin O (ASO) titer was negative. Chest imaging (computerised tomogram scan) showed bullous changes in the upper lobes of the lung, a large area of soft tissue density in the subcutaneous tissue of right upper back, and enlarged right trapezius muscle. His deep-seated abscess was drained and cultured, which subsequently grew Staphylococcus lugdunensis sensitive to methicillin, so the patient was started on intravenous Nafcillin. A skin biopsy taken from the back was sent for histopathology and showed fibroadipose tissue and skeletal muscle with focal acute and chronic inflammation with granulation tissue. These histopathological findings were consistent with scleredema diabeticorum.