Age: 17.0
Sex: F
Vaccine: MNQ
Symptoms: Computerised tomogram abnormal, Computerised tomogram head abnormal, Culture negative, Dermatitis, Double stranded DNA antibody positive
Clinical narrative: This case was reported in a literature article and described the occurrence of systemic lupus erythematosus in a 17-year-old female patient who received MENVEO. On an unknown date, the patient received MENVEO at an unknown dose. On an unknown date, less than a day after receiving MENVEO, the patient experienced systemic lupus erythematosus (serious criteria hospitalization and GSK medically significant), feeling unwell (serious criteria hospitalization), fever (serious criteria hospitalization), fatigue (serious criteria hospitalization), erythematous rash (serious criteria hospitalization), neck pain (serious criteria hospitalization), maculopapular rash (serious criteria hospitalization), periorbital swelling (serious criteria hospitalization), perioral dermatitis (serious criteria hospitalization), lip dry (serious criteria hospitalization), chapped lips (serious criteria hospitalization), mouth ulcer (serious criteria hospitalization), purpura (serious criteria hospitalization), lymphadenopathy cervical (serious criteria hospitalization), pancytopenia (serious criteria hospitalization and GSK medically significant) and skin lesion (serious criteria hospitalization). The patient was treated with cefadroxil, Antibiotic (Drug Name Unknown), prednisone, Mycophenolate and PLAQUENIL. On an unknown date, the outcome of the systemic lupus erythematosus, feeling unwell, fever, fatigue, erythematous rash, neck pain, maculopapular rash, periorbital swelling, perioral dermatitis, lip dry, chapped lips, mouth ulcer, purpura, lymphadenopathy cervical and pancytopenia were recovering/resolving and the outcome of the skin lesion was unknown. The reporter considered the systemic lupus erythematosus, feeling unwell, fever, fatigue, erythematous rash, neck pain, maculopapular rash, periorbital swelling, perioral dermatitis, lip dry, chapped lips, mouth ulcer, purpura, lymphadenopathy cervical, pancytopenia and skin lesion to be related to MENVEO. Additional information was provided. This case was reported in a literature article and described the occurrence of systemic lupus erythematosus in a 17-year-old female who was vaccinated with MENVEO (GlaxoSmithKline). The patient was a previously healthy female. Her immunizations were up to date. The patient had no history of vaccine reactions, allergic reactions, recent travel, known sick contacts, animal exposure, or significant outdoor activity. She did not take any medications regularly. No information on family history was provided. On an unspecified date, the patient received MENVEO (administration route and site unspecified; dosages unknown; batch number not provided). On an unspecified date, an evening after the vaccination, the patient began to feel ill. 5 days prior to the emergency department (ED) visit, the patient developed a progressive, erythematous, non-pruritic, non-painful facial rash. Prior to ED presentation, the patient received 2 days of cefadroxil and there was no improvement in her symptoms. Review of systems was positive only for mild right-sided neck pain. 15 days after receiving the vaccine, the patient presented to ED with 14 days of fever and fatigue. Initial vital signs included a blood pressure of 110/61 mmHg, heart rate of 102 bpm, respiratory rate of 20, an oxygen saturation of 97% and a temporal temperature of 102.4 degree F (39.1 deg. C). She was an ill appearing female with a non-blanching, erythematous maculopapular facial rash, including the right periorbital region and bilateral upper cheeks, with extension to the right ear. The rash was associated with mild right periorbital swelling, as well as perioral dermatitis and dry, chapped lips. She had a painless ulceration of the hard palate. Her first, second, and third fingertips revealed non-painful, purpuric lesions bilaterally. Neck exam was significant for palpable right posterior cervical chain lymphadenopathy without meningismus. The remainder of her exam was unremarkable. Complete blood count (CBC) revealed pancytopenia. The white blood cells (WBC) was 2.8 (neutrophils 48% with 13% bands; there were 35% lymphocytes and 4% monocytes); the HgB was 10.2 and the platelets were 48,000 (normal values not provided). The D-dimer and erythrocyte sedimentation rate (ESR) were elevated at 1.38 and 40, respectively. Urinalysis showed protein, blood, and leukocytes. All other initial labs were unremarkable, electrocardiogram (EKG) and chest x-ray (CXR) were normal. Computed tomography (CT) of the head and neck revealed diffuse bilateral lymphadenopathy. The patient was admitted to the Medical intensive care unit (ICU). On Day 2, despite empiric antibiotic therapy, the patient's CBC demonstrated worsening pancytopenia, with WBC 1.7. Prednisone was started and her pancytopenia began to resolve. All cultures were negative and antibiotics were discontinued on Day 5. On Day 7 she was started on the immunosuppressant CELLCEPT; her fever and rash improved. Serological testing was positive for SLE (antinuclear antibodies titer of 1:320 and anti-double-stranded deoxyribonucleic acid titer of 1:640). On Day 9, the patient was discharged with prednisone and mycophenolate and PLAQUENIL. At one-month follow up, the patient was doing well. This case has been considered serious due to hospitalisation. The authors commented, 'In our case, the extreme proximity of the vaccination to the clinical symptoms, and the pathognomonic serologic findings argues in favour of a cause and effect relationship between the vaccine and classical SLE'. The author stated, 'Our case highlights the importance of inquiring about recent vaccinations in any patient presenting with the unexplained onset of symptoms typical of autoimmune disease'.