Age: 73.0
Sex: F
Vaccine: FLUX
Symptoms: Pruritus, Renal disorder, Skin abrasion, Urine output decreased
Clinical narrative: ANCA vasculitis with acute fulminant pulmonary and renal manifestations; This literature case was received from other healthcare professional on 09-Oct-2023 and concerned a 73-year-old, female patient.   The aim of this conference abstract was to report a case of Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis with acute fulminant pulmonary and renal manifestations after flu vaccination.  The patient's concurrent conditions included hypertension and gastro-esophageal reflux diseases. The patient's concomitant medications were not reported.  On an unspecified date in 2023, reported as two months ago, the patient was vaccinated with influenza vaccine (brand not specified; dose, route of administration, anatomical location, and indication: not reported). The batch number was not reported.   On an unspecified date in 2023, within few days after receiving influenza vaccine, the patient developed lethargy. The patient experienced with progressive shortness of breath and cough for two weeks. She also reported associated generalized pruritus and decreased urine output.  On an unspecified date in 2023, the patient was hospitalized. On admission she was afebrile, heart rate was 82 beats per minute, blood pressure was 164/82 mm of Hg and oxygen saturation was 98% on room air. Physical examination was notable for multiple excoriations on skin, conjunctival pallor, and disorientation to time. Initial laboratory workup was significant for sodium of 120 mg/dL, potassium of 2.9 mg/dL, blood urea nitrogen 147 mg/dL, creatinine 17.03 mg/dL, and creatinine phosphokinase 1710 IU/L. Computed tomography (CT) of chest showed features of early usual interstitial pneumonitis. She was started on hemodialysis.  On an unspecified date in 2023, CT scan of chest was repeated for worsening hypoxemia, mild hemoptysis which showed diffuse ground glass opacities. Antinuclear antibodies (ANA), perinuclear ANCA (p-ANCA), myeloperoxidase (MPO) returned positive. Bronchoalveolar lavage (BAL) and transbronchial biopsy were negative for diffuse alveolar hemorrhage, active inflammation, organism, granuloma, and malignancy. Renal biopsy showed pauci-immune glomerulonephritis with mixed active and fibrous crescents. She was marked improved clinically and radiologically after receiving pulse dose of methylprednisolone and one dose of rituximab.  At the time of initial reporting, on 09-Oct-2023, the patient was recovering from the event. As reported, she was marked improved clinically and radiologically after receiving pulse dose of methylprednisolone and one dose of rituximab.  The reporter assessed the event of ANCA-associated vasculitis as possibly related to the influenza vaccine. As reported, a unique case of ANCA vasculitis with acute fulminant pulmonary and renal manifestations, suspected to be triggered after flu vaccination.  The event was considered to be serious due to seriousness criterion of hospitalization.  In conclusion, vasculitis following influenza vaccination has been rarely reported, with usual timeline of presentation within one month. However, further studies need to be conducted to establish temporal association between the two. Suspicion for rare vasculitides in patients with unexplained symptom complexes post vaccination. Caution should also be required in patients with small vessel vasculitis who receives flu vaccination again.  Company comment: A 73-year-old patient experienced lethargy, progressive dyspnoea, cough, generalized pruritus, and decreased urine output within few days after receiving the suspect product influenza vaccine. Thereafter the patient was hospitalized, and on admission had hypertension (164/82 mm of Hg). Physical examination was notable for multiple excoriations on skin, conjunctival pallor, and disorientation to time. Initial laboratory workup was significant for hyponatremia, hypokalaemia, and high level of blood urea nitrogen, creatinine, and creatinine phosphokinase. The patient underwent computed tomography of chest which showed early usual interstitial pneumonitis and diffuse ground glass opacities. Additional laboratory results indicated positive findings for antinuclear antibodies, perinuclear ANCA, and myeloperoxidase. The patient's concomitant drugs were not provided. Based on available information and in line with the reporter's assessment, causality between the suspect vaccine and the event of anti-neutrophil cytoplasmic antibody positive vasculitis is assessed as possibly related.; Reporter's Comments: A unique case of ANCA vasculitis with acute fulminant pulmonary and renal manifestations, suspected to be triggered after flu vaccination.; Sender's Comments: A 73-year-old patient experienced lethargy, progressive dyspnoea, cough, generalized pruritus, and decreased urine output within few days after receiving the suspect product influenza vaccine. Thereafter the patient was hospitalized, and on admission had hypertension (164/82 mm of Hg). Physical examination was notable for multiple excoriations on skin, conjunctival pallor, and disorientation to time. Initial laboratory workup was significant for hyponatremia, hypokalaemia, and high level of blood urea nitrogen, creatinine, and creatinine phosphokinase. The patient underwent computed tomography of chest which showed early usual interstitial pneumonitis and diffuse ground glass opacities. Additional laboratory results indicated positive findings for antinuclear antibodies, perinuclear ANCA, and myeloperoxidase. The patient's concomitant drugs were not provided. Based on available information and in line with the reporter's assessment, causality between the suspect vaccine and the event of anti-neutrophil cytoplasmic antibody positive vasculitis is assessed as possibly related.