Sex: F
Vaccine: FLU4
Symptoms: Periorbital oedema, Protein urine present, Proteinuria, Renal function test normal, Urine abnormality
Clinical narrative: This case was reported in a literature article and described the occurrence of minimal change disease in a 45-year-old female patient who received Influenza vaccine Quadrivalent. The patient's past medical history included edema (bilateral hand, facial, and lower extremity oedema), urine abnormality (frothy urine), minimal change disease and proteinuria. Previously administered products included prednisone (1 mg/kg daily), torsemide (5 mg/day) and rosuvastatin (5 mg/day). In October 2016, the patient received Influenza vaccine Quadrivalent. On an unknown date, unknown after receiving Influenza vaccine Quadrivalent, the patient experienced minimal change disease (serious criteria GSK medically significant), periorbital edema, urine abnormality and proteinuria. The patient was treated with prednisone. On an unknown date, the outcome of the minimal change disease, periorbital edema, urine abnormality and proteinuria were recovered/resolved. The reporter considered the minimal change disease, periorbital edema, urine abnormality and proteinuria to be related to Influenza vaccine Quadrivalent. Additional information was provided. This case was reported in a literature article and described the occurrence of minimal change disease (MCD) relapse in a 45-year-old female patient who was vaccinated with unspecified influenza vaccine (manufacturer unknown). The patient was a woman. The patient had no significant past medical or allergy history and no signs of systemic infection. She was normotensive. In December 2014, the patient presenting with abrupt onset of bilateral hand, facial, and lower extremity oedema, and frothy urine. Urinalysis (UA) showed 3+ protein and urine protein-to-creatinine (UPCR) was 6.5 g/g. Serum albumin was 1.5g/dL, total cholesterol 465 mg/dL, white blood cells (WBCs) 6.79K/mm3, haemoglobin (Hgb) 14.5 g/dL, platelets 417K/mm3, blood urea nitrogen (BUN) 20 mg/dL, creatinine 1.0 mg/dL, aminotransferase (AST) 29 IU/L, alanine aminotransferase (ALT) 20 IUL/L, C3 155mg/dL, and C4 29.3mg/dL. RPR (rapid plasma regain), hepatitis B and C serologies, and antinuclear antibody (ANA) were negative. After approximately 2 weeks, UPCR worsened to 12 g/g. A kidney biopsy showed minimal change disease (MCD) and oral prednisone 1 mg/kg daily was started in addition to torsemide 5 mg/day and rosuvastatin 5 mg/day. Complete remission of proteinuria was documented 2 weeks later and persisted after completing a 6-month course of prednisone. Patient remained in complete remission until October 2016. No information on patient's family history was provided. On an unspecified date in October 2016, the patient received unspecified influenza vaccine (administration route and site unspecified; dosages unknown; batch number not provided). Age of vaccination was not provided. On an unspecified date, just after receiving unspecified influenza vaccination, the patient developed periorbital oedema and frothy urine. The patient denied recent infections or nonsteroidal anti-inflammatory drugs (NSAIDs) use. She was normotensive. Renal and hepatic chemistries were normal with creatinine 0.7 mg/dL except for serum albumin of 3.0 g/dL. Urine analysis showed protein 100 mg/dL and 24 hour proteinuria was 1.5 g. Relapse of MCD was attributed to recent influenza vaccination in the absence of other potential triggers of MCD. The patient was treated with oral prednisone 50mg/day and proteinuria resolved within 21 days. The authors considered the event of MCD relapse related to unspecified influenza vaccine. The author stated, "Our case as well as previous anecdotal reports suggest that influenza vaccination and the resulting stimulation of the immune system may cause MCD. This finding demands further investigation in the pathophysiology of MCD and also requires consideration of further vaccinations in this patient population."