Age: 56.0
Sex: M
Vaccine: FLUX
Symptoms: Nephrotic syndrome, Oedema, Proteinuria, Renal function test normal, Tubulointerstitial nephritis
Clinical narrative: Initial unsolicited report received from the literature on 23 November 2015. This case is linked to 2015SA196255 (same literature). The following is verbatim from the article: ABSTRACT: Immunization with influenza vaccine remains an important global health strategy to prevent outbreaks and epidemics of seasonal influenza. Influenza vaccine has rarely been associated with vasculitis, acute kidney injury (AKI) and nephrotic syndrome (NS). Glomerular diseases following influenza vaccination have also been rarely reported. We report a patient who developed acute-onset massive proteinuria with NS and severe AKI soon after receiving the 2009 H1N1 influenza vaccine. Kidney biopsy showed membranes nephropathy (MN) and acute interstitial nephritis (AIN). Optimal management of glomerular diseases or AIN following influenza vaccination is not known. Our patient responded well to an initial course of oral corticosteroid therapy with normalization of serum creatinine level but had a relapse of NS with AKI soon after completion of corticosteroid therapy. A repeat kidney biopsy revealed MN and resolved AIN. A subsequent prolonged course or oral corticosteroids resulted in complete clinical remission of the NS as well as normalization of renal function. Long-term response to corticosteroid therapy in such cases is not known. However, our patient continued to remain in clinical remission with normal renal function, five years after the initial treatment. In conclusion, we present an interesting case of MN and severe AKI following the 2009 H1N1 influenza vaccination. Optimal therapy of influenza vaccine-associated glomerular diseases including MN is unknown. Our patient remains in clinical remission with normal renal function, five years after completion of corticosteroid therapy. Based on our experience, one can consider corticosteroid therapy in patients with MN and AIN following influenza vaccination. However, further studies are required to investigate the exact pathogenesis of influenza vaccine-induced MN. This case involves a 56-year-old male patient who was vaccinated with a dose of 2009 H1N1 influenza vaccine (batch number, expiration date, dose, dose number, route and site of administration were not reported) on an unspecified date. Medical history and concomitant medication was not reported. On an unspecified date, 20 days after vaccination patient developed influenza-like illness and acute-onset NS (Nephrotic Syndrome). On an unspecified date, patient had experienced edema and proteinuria. On an unspecified date, after two weeks following vaccination patient experienced abrupt-onset nephrotic syndrome (NS) with massive proteinuria and severe acute kidney injury (AKI). Laboratory investigation involved kidney biopsy revealed MN (Membranous Nephropathy) and AIN (Acute Interstitial Nephritis). Corrective treatment involved steroids (both edema and proteinuria subsided), oral corticosteroids, angiotensin-converting enzyme inhibitor, a statin, acetylsalicylic acid and methylprednisolone. The patient was recovering from the above mentioned events. Upon internal review, the company decided to consider the event serious because of the important medical event: influenza-like illness, relapsed, severe AKI (acute kidney injury, edema, proteinuria/massive proteinuria and acute-onset NS/abrupt onset of NS. List of documents held by sender: none.