Age: 89.0
Sex: F
Vaccine: FLUX, FLUX, FLUX
Symptoms: Nuclear magnetic resonance imaging normal, Palpable purpura, Pancytopenia, Papule, Post inflammatory pigmentation change
Clinical narrative: This case was reported in a literature article and described the occurrence of leukocytoclastic vasculitis in a 89-year-old female patient who received Influenza vaccine. Co-suspect products included Influenza vaccine. The patient's past medical history included paraproteinemia. Concurrent medical conditions included diabetes mellitus and hypertension. On an unknown date, the patient received Influenza vaccine at an unknown dose and Influenza vaccine at an unknown dose. On an unknown date, 11 days after receiving Influenza vaccine and not applicable after receiving Influenza vaccine, the patient experienced leukocytoclastic vasculitis (serious criteria GSK medically significant), thrombocytopenia (serious criteria GSK medically significant), itchy rash, red macule, palpable purpura, papule, anemia, leukocytoclastic vasculitis (serious criteria GSK medically significant), pancytopenia (serious criteria GSK medically significant), red macule and palpable purpura. On an unknown date, the outcome of the leukocytoclastic vasculitis, thrombocytopenia, itchy rash, red macule, palpable purpura, papule, leukocytoclastic vasculitis, pancytopenia, red macule and palpable purpura were recovered/resolved and the outcome of the anemia was unknown. The reporter considered the leukocytoclastic vasculitis, thrombocytopenia, itchy rash, red macule, palpable purpura, papule and anemia to be related to Influenza vaccine. The reporter considered the leukocytoclastic vasculitis, pancytopenia, red macule and palpable purpura to be related to Influenza vaccine. Additional information was provided: This case was reported in a literature article and described the occurrence of leukocytoclastic vasculitis (LCV) in an 89-year-old female patient who was vaccinated with unspecified influenza vaccine (manufacturer unknown). The patient had well-controlled diabetes mellitus and hypertension. The patient had a history of paraproteinemia. The patient had not received any other medications before either incident. No information on patient's family history or concurrent condition was provided. On an unspecified date during the fall season, at the age of 89 years, the patient received unspecified influenza vaccine (administration route and site unspecified; dosage unknown; batch number not provided). On an unspecified date, 11 days after vaccination with unspecified influenza vaccine, the patient developed pruritic eruption on the legs. 3 days later, the patient presented with same symptoms. On examination, the patient had non-blanching erythematous-to-violaceous macules that coalesced into patches, in addition to palpable purpura, on the bilateral lower extremities. The patient otherwise felt well and denied fever, chills, dysuria, nausea, vomiting, abdominal pain, or upper respiratory symptoms. The patient denied taking new medications. Biopsy findings from a purpura papule on the thigh were consistent with LCV. Complete blood count showed mild anaemia and thrombocytopenia. Urinalysis result was within normal limits (values not provided). The haematology department determined that there was a possibility of lymphoma; however, the patient was otherwise asymptomatic and elected to monitor rather than intervene. 5 days after initial presentation, the eruption was markedly improved, with predominantly post inflammatory hyperpigmentation remaining. 1 year later, at the age of 90 years, the patient again received unspecified influenza vaccine (administration route and site unspecified; dosage unknown; batch number not provided). 11 days after vaccination with unspecified influenza vaccine, the patient presented with a recurrence of scattered erythematous non-blanching macules and palpable purpura on the bilateral lower extremities. Similar to the previous episode, review of systems was otherwise negative. The patient denied taking new medications or having recent infection. Complete blood count showed mild pancytopenia and urinalysis result was within normal limits (values not provided for both). During the interim period, the patient had undergone radiologic imaging and had no evidence of a clinically significant lymphoma. Subsequently, the final diagnosis was suspected to be LCV secondary to the influenza vaccine, given the identical onset of the episodes 11 days after vaccination and complete resolution between the 2 exposures. Treatment for both episodes was unknown. The patient had complete resolution within 3 weeks of both episodes and had no disease activity between episodes. The patient was counseled to avoid the influenza vaccine next year. The authors considered the event of LCV related to unspecified influenza vaccine. The author stated "Although the timing of the patient's episodes of LCV provides strong support for the vaccine's role, we must consider the possibility that an underlying paraproteinemia may have made the patient more susceptible to the eruption". The authors concluded that "Although the timing of the patient's episodes of LCV provides strong support for the vaccine's role, we must consider the possibility that an underlying paraproteinemia may have made the patient more susceptible to the eruption. Previous cases attributed to a vaccine had no other identified precipitating factors. However, we propose that it is prudent to perform a thorough search for additional etiologic agents, such as paraproteinemia, particularly in a patient with recurrent LCV".