Sex: F
Vaccine: FLUX
Symptoms: Obstructive airways disorder, Pulmonary function test abnormal, Rash vesicular, Toxic epidermal necrolysis
Clinical narrative: Initial unsolicited report received from the literature on 17-Jul-2018. This case involves a 31 years old female patient who experienced Obliterative bronchiolitis, toxic epidermal necrolysis, blistering rash to her face, neck, chest, back, abdomen, arms, lips, anus, and genitals, non-productive cough, progressive dyspnea on exertion and bilateral central bronchiectasis, while she received vaccine INFLUENZA VACCINE. The patient's past medical history, medical treatment(s), vaccination(s) and family history were not provided. On an unknown date, the patient received a dose of suspect INFLUENZA VACCINE via intramuscular route produced by unknown manufacturer lot number not reported. On an unknown date, the patient developed a serious Obliterative bronchiolitis, toxic epidermal necrolysis (TEN), blistering rash to her face, neck, chest, back, abdomen, arms, lips, anus, and genitals, non-productive cough, progressive dyspnea on exertion and bilateral central bronchiectasis, following the administration of INFLUENZA VACCINE. The patient was hospitalized for these events. It was reported that the patient was admitted to the medical intensive care unit with a blistering rash to her face, neck, chest, back, abdomen, arms, lips, anus, and genitals after intramuscular influenza vaccine. The patient underwent skin biopsy which was consistent with TEN. She required endotracheal intubation and mechanical ventilator support and was successfully extubated after 14 days. Flexible bronchoscopy did not reveal any abnormalities. She was discharged home without requiring supplemental oxygen. She presented to a primary care visit 5 months after her episode of TEN with progressive dyspnea on exertion and non-productive cough. Prior to developing TEN, she had no pulmonary diagnoses or complaints. She was prescribed an albuterol inhaler without improvement in her symptoms. She was referred for a pulmonary evaluation. Further testing with repeat PFTs revealed persistent non-reversible airflow obstruction. She did not desaturate on six-minute walk test. She was subsequently started on oral prednisone for treatment of OB with improvement in her dyspnea but no improvement in airflow obstruction. Relevant tests included flexible bronchoscopy did not reveal any abnormalities. Pulmonary function tests (PFT) were obtained and showed a forced expiratory volume (FEV1) /forced vital capacity (FVC) 85 percent with FEV1 0.79L (39 percent) and no bronchodilator response. Final diagnosis was bilateral central bronchiectasis, progressive dyspnea on exertion, non-productive cough, blistering rash to her face, neck, chest, back, abdomen, arms, lips, anus, and genitals, toxic epidermal necrolysis and Obliterative bronchiolitis. The patient was treated with ALBUTEROL [SALBUTAMOL] (ALBUTEROL [SALBUTAMOL]) inhaler and PREDNISONE (PREDNISONE). The outcome of the events was not reported. This case was considered as Life Threatening as patient was transferred to medical intensive care unit and required mechanical ventilator due to events toxic epidermal necrolysis (TEN) and blistering rash to her face, neck, chest, back, abdomen, arms, lips, anus, and genitals. List of documents held by sender: none.; Sender's Comments: This case concerns an adult patient who presented with obliterative bronchiolitis, toxic epidermal necrolysis, blistering rash, cough, dyspnea and bronchiectasis after vaccination with INFLUENZA vaccine (unknown manufacturer). The time to onset is not known. Moreover, there is no information regarding patient's condition at time of vaccination and lab tests do not rule out alternate etiologies, particularly infectious. Based upon the reported information, the role of the vaccine cannot be assessed.