Sex: M
Vaccine: FLUX
Symptoms: Complement factor C4 decreased, Computerised tomogram abdomen abnormal, Cough, Diarrhoea haemorrhagic, Double stranded DNA antibody
Clinical narrative: This case was reported in a literature article and described the occurrence of henoch-schonlein purpura in a 19-year-old male patient who received Flu unspecified (Influenza vaccine) for prophylaxis. Co-suspect products included Flu unspecified (Influenza vaccine) for prophylaxis. Concurrent medical conditions included seasonal allergy. On an unknown date, the patient received Influenza vaccine (subdermal) 1 and the 2nd dose of Influenza vaccine (intramuscular). On an unknown date, 2 days after receiving Influenza vaccine and Influenza vaccine, the patient experienced henoch-schonlein purpura (serious criteria hospitalization), hematochezia (serious criteria hospitalization and GSK medically significant), malaise (serious criteria hospitalization), myalgia, vomiting (serious criteria hospitalization), headache (serious criteria hospitalization), weakness (serious criteria hospitalization), purpuric rash (serious criteria hospitalization), leukocytosis (serious criteria hospitalization), abdominal pain (serious criteria hospitalization), bloody diarrhea (serious criteria hospitalization and GSK medically significant), scrotal pain (serious criteria hospitalization), varicocele (serious criteria hospitalization), gastrointestinal wall thickening (serious criteria hospitalization), gastrointestinal bleeding (serious criteria hospitalization and GSK medically significant), rhinorrhea, dry cough, overdose and intramuscular formulation administered by other route. The patient was treated with methylprednisolone and prednisone. On an unknown date, the outcome of the henoch-schonlein purpura, hematochezia, malaise, myalgia, vomiting, headache, weakness, purpuric rash, leukocytosis, abdominal pain, bloody diarrhea, scrotal pain, varicocele, gastrointestinal wall thickening, gastrointestinal bleeding, rhinorrhea and dry cough were recovered/resolved and the outcome of the overdose and intramuscular formulation administered by other route were unknown. The reporter considered the henoch-schonlein purpura, hematochezia, malaise, myalgia, vomiting, headache, weakness, purpuric rash, leukocytosis, abdominal pain, bloody diarrhea, scrotal pain, varicocele, gastrointestinal wall thickening, gastrointestinal bleeding, rhinorrhea, dry cough and overdose to be related to Influenza vaccine and Influenza vaccine. Additional information was provided. This case was reported in a literature article and described the occurrence of IgA vasculitis (Henoch-Schonlein Purpura (HSP)) in a 19-year-old male patient who was vaccinated with influenza vaccine (manufacturer unknown) prophylaxis. The patient referred severe seasonal allergies as relevant past medical history. No information on patient's family or concomitant medication or concurrent condition was provided.  On an unspecified date, the patient had received 1 dose of unspecified influenza vaccine mistakenly administered sub-dermally (administration site unspecified, batch number not provided). Same day, the patient received additional 1 dose given intramuscularly. On an unspecified date, 2 days after vaccination, the patient developed dry cough, rhinorrhoea, malaise and diffuse myalgia. In February, the patient was presented to an emergency department with a history of three episodes of vomiting for the last two days accompanied by headache, malaise and weakness. It was reported that the patient received vaccination 10 days before the start of symptoms. A purpuric rash on the extremities was noted which was not associated with pain, burning sensation or pruritus. On the initial physical examination, he was well appearing, afebrile, and with normal vital signs. There was no oropharyngeal erythema, oral lesions or lymphadenopathy. A palpable non-blanching purpuric rash on the calves, knees and elbows (but most prominent on the ankles) was evident. The rest of the physical examination was unremarkable. The patient had leukocytosis (11,500 WBC/µL) with 80% neutrophils and normal platelet counts (232,000 platelets/µL). Urinalysis, creatinine and liver function tests were within normal limits; C-reactive protein was 7.4 mg/dL (reference less than 3 mg/dL). A respiratory viral panel, human immunodeficiency virus, enzyme-linked immunosorbent assay, rapid plasma reagin test (RPR), HBsAg and HCV antibodies were negative. Both chest X-ray and cerebrospinal fluid (CSF) analyses showed no abnormalities. C3 and C4 levels were decreased but the rest of the rheumatologic panel (anti-dsDNA, Anti-Ro, Anti-La, Anti-SM, Anti-RMP and antineutrophil cytoplasmic antibodies) was negative. After 72 h in hospital, he developed abdominal pain, bloody diarrhoea and left scrotal pain; testicular ultrasound showed mild varicocele and an abdominal CT scan showed thickening of the ascending colon walls. The patient received symptomatic pain management, along with one dose of intravenous methylprednisolone, followed by three additional doses of oral prednisone when the gastrointestinal bleeding resolved. He was discharged once the oral corticosteroid regimen was completed, as there was no recurrence of the gastrointestinal bleeding. The rest of the symptoms resolved within two weeks after hospital admission. At six months of follow up, the patient did not have any recurrence and never developed kidney dysfunction. Based on the clinical presentation, the presence of palpable skin purpura and diffuse abdominal pain with hematochezia, a clinical diagnosis of IgA vasculitis or Henoch-Schonlein Purpura (HSP) was made. This case has been considered serious due to hospitalisation. The author commented, "In our case, the large antigenic trigger due to the unusual dose may have contributed to the development of the disease." The author stated, "Finally, due to the obvious benefits of influenza vaccination, it is not recommended to limit this immunization to the general population. However, its safety in patients with prior diagnosis of vasculitis is still debatable". Lab Comments: Laboratory tests were performed on unspecified dates. On the initial physical examination, he was well appearing, afebrile, and with normal vital signs. There was no oropharyngeal erythema, oral lesions or lymphadenopathy. A palpable non-blanching purpuric rash on the calves, knees and elbows (but most prominent on the ankles) was evident. The rest of the physical examination was unremarkable. Rheumatologic panel (anti-dsDNA, Anti-Ro, Anti-La, Anti-SM, Anti-RMP and antineutrophil cytoplasmic antibodies) was negative. HCV antibodies were negative. Testicular ultrasound showed mild varicocele and an abdominal CT scan showed thickening of the ascending colon walls.