Sex: M
Vaccine: FLUX
Symptoms: Autopsy, CSF protein increased, CSF test normal, Death, Electromyogram abnormal
Clinical narrative: This case was reported in a literature article and described the occurrence of acute disseminated encephalomyelitis in a 65-year-old male patient who received Flu unspecified (Influenza vaccine) for prophylaxis. Concurrent medical conditions included hiv infection (CD4 count 533/uL), hypertension, type ii diabetes mellitus and blindness. On an unknown date, the patient received Influenza vaccine at an unknown dose. On an unknown date, less than a week after receiving Influenza vaccine, the patient experienced acute disseminated encephalomyelitis (serious criteria death and GSK medically significant), weakness in extremity (serious criteria hospitalization), respiratory failure (serious criteria hospitalization and GSK medically significant), quadriplegia (serious criteria hospitalization and GSK medically significant), nystagmus (serious criteria hospitalization) and multilobar pneumonia (serious criteria hospitalization and GSK medically significant). The patient was treated with immunoglobulins nos (Immunoglobulin) and steroids nos (Steroids). On an unknown date, the outcome of the acute disseminated encephalomyelitis was fatal and the outcome of the weakness in extremity, respiratory failure, quadriplegia, nystagmus and multilobar pneumonia were unknown. The reported cause of death was acute disseminated encephalomyelitis. An autopsy was performed. The autopsy determined cause of death was acute disseminated encephalomyelitis. It was unknown if the reporter considered the acute disseminated encephalomyelitis, weakness in extremity, respiratory failure, quadriplegia, nystagmus and multilobar pneumonia to be related to Influenza vaccine. Additional information was provided. This case was reported in a literature article and described the occurrence of acute disseminated encephalomyelitis in a 65-year-old male who was vaccinated with unspecified influenza vaccine (manufacturer unknown) for prophylaxis. The patient had a history of human immunodeficiency virus (HIV) infection (CD4 count 533/uL), hypertension, diabetes mellitus type II and blindness. No information on patient's family history or concomitant medication was provided.  On an unspecified date, the patient received unspecified influenza vaccine (administration site and route unspecified; dosages unknown; batch number not provided). The age of vaccination was not provided. On an unspecified date, 3 days after vaccination, the patient presented to hospital with acute weakness of all extremities. Subsequently, the patient was admitted. Initial laboratory workup showed elevated protein in cerebrospinal fluid and no evidence of infection. anti-nuclear,-VGCC,-MUSK and-GQ1b antibodies were negative. The patient was treated with intravenous immunoglobulin and steroids for possible Guillain-Barre Syndrome, however his condition deteriorated, and the patient developed respiratory failure requiring mechanical ventilation, complete quadriplegia, nystagmus, and multilobar pneumonia. Electromyography (EMG) demonstrated a severe diffuse demyelinating pattern. On day 16, brain magnetic resonance imaging (MRI) showed innumerable foci of T2 flair hyperintensity involving brain and spinal cord. On day 17 of hospitalisation, the patient died and permission for autopsy was granted. Neuropathologic examination showed multiple soft lesions with tan discoloration throughout the brain and spinal cord, predominantly involving periventricular white matter, bilateral basal ganglia, corpus callosum, cerebellar white matter, pons, medulla and upper cervical spinal cord. Microscopic examination showed discrete areas of demyelination surrounding vessels, with patchy macrophage aggregation, sparse CD8+ lymphocyte infiltration and mild reactive gliosis at the periphery. In a few of the lesions, the infiltrate was composed of neutrophils. Inflammation when present was perivascular or in the brain parenchyma and did not involve the vessel wall. No haemorrhage or viral inclusions were identified. Luxol fast blue stain demonstrated loss of myelin within the lesions. Neurofilament immunohistochemical stain highlighted relative preservation of axons, although spheroids and axonal disruption were also present. The findings were most consistent with the diagnosis of acute disseminated encephalomyelitis (ADEM) in a patient with HIV infection and recent influenza vaccination. This case has been considered serious due to death/hospitalisation. The authors stated, "ADEM presentation in patients with HIV may be atypical and should be considered with acute rapid worsening of weakness, especially in temporal relationship to vaccination". Lab Comments: Lab tests were performed on unspecified dates Anti-nuclear,-VGCC,-MUSK and-GQ1b antibodies were negative.Electromyography (EMG) demonstrated a severe diffuse demyelinating pattern. Neuropathologic examination showed multiple soft lesions with tan discoloration throughout the brain and spinal cord, predominantly involving periventricular white matter, bilateral basal ganglia, corpus callosum, cerebellar white matter, pons, medulla and upper cervical spinal cord. Microscopic examination showed discrete areas of demyelination surrounding vessels, with patchy macrophage aggregation, sparse CD8+ lymphocyte infiltration and mild reactive gliosis at the periphery. In a few of the lesions, the infiltrate was composed of neutrophils. Inflammation when present was perivascular or in the brain parenchyma and did not involve the vessel wall. No haemorrhage or viral inclusions were identified. Luxol fast blue stain demonstrated loss of myelin within the lesions. Neurofilament immunohistochemical stain highlighted relative preservation of axons, although spheroids and axonal disruption were also present. The findings were most consistent with the diagnosis of acute disseminated encephalomyelitis (ADEM) in a patient with HIV infection and recent influenza vaccination.; Reported Cause(s) of Death: Acute disseminated encephalomyelitis; Autopsy-determined Cause(s) of Death: Acute disseminated encephalomyelitis.