Age: 60.0
Sex: F
Vaccine: PPV
Symptoms: Immunoglobulin therapy, Magnetic resonance imaging spinal normal, Muscular weakness, Nerve conduction studies abnormal, Purpura
Clinical narrative: vasculitic neuropathy / vasculitic neuropathy is a rare subtype of immune-mediated neuropathy; weakness / acute onset lower extremity weakness; distal symmetric axonopathy due to vasculitic neuropathy; This literature marketed report has been received from the authors of a published literature article and refers to a 60-year-old, female (reported as a woman) patient. She was healthy, non-diabetic. Her medical history, concomitant medications, previous drugs or allergies were not provided.  Several autoimmune disorders have been linked to vaccination. One that stood out was Guillain-Barre syndrome (GBS) following "influenza vaccine" (unspecified). Molecular mimicry was a proposed mechanism. As opposed to GBS, the vasculitic neuropathy was a rare subtype of immune-mediated neuropathy. It might or might not have been associated with systemic vasculitis. The most common phenotype was multifocal neuropathy known as mononeuritis multiplex. To the best of knowledge, distal symmetric axonopathy due to vasculitic neuropathy has not been described following pneumococcal vaccination.  On an unknown date, previously healthy, non-diabetic woman developed purpuric rash 3 days after she received a Pneumococcal Vaccine, Polyvalent (23-valent) (manufacturer unknown) (dose, strength, route of administration, anatomical location, lot # and expiration date were not reported) for prophylaxis. The rash was biopsied showing vasculopathy. For persistent eosinophilia, that was noted after vaccination, she underwent bone marrow biopsy without any evidence of malignancy. On an unspecified date, she developed acute onset lower extremity weakness worse in distal muscles. She became non-ambulatory prompting her admission to neurology service. Cerebrospinal fluid was normal, spine magnetic resonance imaging scans (MRI) were negative. Nerve Conduction Studies (NCSs) and Electromyography (EMG) revealed acute axonal neuropathy (also reported as distal symmetric axonal neuropathy). She was treated with intravenous (IV) immunoglobulin G (Ig) for possible axonal GBS without any improvement. On an unknown date, a radial sensory nerve biopsy was undertaken showing perivascular lymphocytes in the epineurial connective tissue. Rheumatology was consulted and confirmed the diagnosis of eosinophilic granulomatosis with polyangiitis. The patient was treated with high dose corticosteroids (unspecified), cyclophosphamide followed by azathioprine. The outcome of the events was not reported (unknown).  Vasculitic neuropathy was a rare entity. When it occurred, the typical presentation was multifocal neuropathy. This case described the unique case of vasculitic neuropathy, that developed in the setting of Pneumococcal Vaccine, Polyvalent (23-valent) (manufacturer unknown) vaccination and presented as a distal symmetric axonal neuropathy causing weakness. The causality between the suspect vaccine and the events was assessed by the authors to be related.  Upon internal review, the event immune-mediated neuropathy was determined to be medically significant.