Sex: M
Vaccine: FLUX, FLUX
Symptoms: Red blood cell sedimentation rate increased, Rheumatoid factor positive, Urine protein/creatinine ratio increased
Clinical narrative: C-ANCA-associated vasculitis; Pauci immune associated Necrotizing/Crescentic glomerulonephritis involving 35% of glomeruli; Migrating oligoarthralgia; lower extremity paresthesia; Rash; Right leg motor deficit; Right eye pain; Fever; Chills; Night sweats; Dactylitis; Enthesitis; flat pruritic petechial rash of the lower extremities; flat pruritic petechial rash of the lower extremities; Hematuria; Bilateral diffuse ground-glass patchy infiltrates; 2-4 mm solid nodules; This case was reported in a literature article and described the occurrence of anca-associated vasculitis in a 48-year-old male patient who received Flu unspecified (Influenza vaccine) for prophylaxis. The patient's past medical history included arthralgia. Previously administered products included Influenza vaccine (for 2 years prior) and short-term steroids (for 2 years prior). Concurrent medical conditions included allergic rhinitis.   On an unknown date, the patient received Influenza vaccine. On an unknown date, 1 week after receiving Influenza vaccine, the patient experienced anca-associated vasculitis (serious criteria GSK medically significant), pauci-immune glomerulonephritis (serious criteria GSK medically significant), arthralgia, paresthesia lower limb, rash, lower limb motor deficit, eye pain, fever, chills, night sweat, dactylitis, enthesitis, petechial rash, itchy rash, hematuria, bilateral pulmonary infiltrates and lung nodule. The patient was treated with steroids nos (Steroids), methylprednisolone sodium succinate (Solu-Medrol), prednisone and rituximab. On an unknown date, the outcome of the anca-associated vasculitis and pauci-immune glomerulonephritis were recovering/resolving and the outcome of the arthralgia, paresthesia lower limb, rash, lower limb motor deficit, eye pain, fever, chills, night sweat, dactylitis, enthesitis, petechial rash, itchy rash, hematuria, bilateral pulmonary infiltrates and lung nodule were unknown.   The reporter considered the anca-associated vasculitis, pauci-immune glomerulonephritis, arthralgia, paresthesia lower limb, rash, lower limb motor deficit, eye pain, fever, chills, night sweat, dactylitis, enthesitis, petechial rash, itchy rash, hematuria, bilateral pulmonary infiltrates and lung nodule to be related to Influenza vaccine.     Additional Information: GSK Receipt Date: 25-AUG-2022 Author comment: The patient developed C-ANCA-associated vasculitis a week after influenza vaccine.   The patient with a history of chronic allergic rhinitis required short-term steroids for arthralgias after yearly influenza vaccine for 2 years prior. The following year he presented 8 weeks after receiving the vaccine with migrating oligoarthralgia, lower extremity paresthesia, rash, right leg motor deficit, right eye pain, fever, chills, and night sweats. Physical exam showed dactylitis, enthesitis, a flat pruritic petechial rash of the lower extremities. A trial of short-term steroids was provided. Symptoms recurred once steroids were titrated. Lab showed increasing creatinine from 1.0 to 3.0 mg/dL, Protein: creatinine (P:Cr) ratio from 0.5 to 1.2 g/day, hematuria, positive rheumatoid factor (RF) 32 (high), C-Reactive Protein 7.5 (high), erythrocyte sedimentation rate (ESR) 42,(high) and Proteinase 3 antibody (PR-3) greater than 8.0 (high) . Computerised tomogram thorax showed bilateral diffuse ground-glass patchy infiltrates and 2-4 mm solid nodules. Skin biopsies showed small and medium-size vasculitis. Renal biopsy showed a Pauci immune associated Necrotizing/Crescentic glomerulonephritis involving 35% of glomeruli. The patient was treated with Solu-Medrol 1000 mg daily x 3 days, followed by prednisone 80 mg daily, Rituximab 1000 mg day 1 and 15, then 500 mg every six months. Steroids were titrated down until discontinuation. At the time of reporting, the patient's creatinine was at baseline 1.0 mg/dl and P:Cr of 334 mg/g.  Influenza-associated vasculitis case reports include new-onset or relapsing ANCA vasculitis. This patient showed high levels of anti-PR3 with pauci-immune pattern. Pauci-immune typifies systemic small-vessel vasculitis which may lead to renal failure or pulmonary hemorrhage. We intend to increase awareness of influenza vaccine-associated ANCA vasculitis as rapid detection and treatment lead to optimal outcomes.