Age: 67.0
Sex: M
Vaccine: FLUX
Symptoms: Laboratory test, Myalgia, Plasmapheresis, Pyrexia, Red blood cell sedimentation rate increased
Clinical narrative: This case was reported in a literature article and described the occurrence of anti-neutrophil cytoplasmic antibody positive vasculitis in a 67-year-old male patient who received Flu Seasonal TIV Dresden. The patient's past medical history included diabetes, hypertension and congestive heart failure. On an unknown date, the patient received Flu vaccine at an unknown dose. On an unknown date, 21 days after receiving Flu vaccine, the patient experienced anti-neutrophil cytoplasmic antibody vasculitis (serious criteria hospitalization and GSK medically significant), fever (serious criteria hospitalization), myalgia (serious criteria hospitalization), acute kidney injury (serious criteria hospitalization and GSK medically significant), hyperkalemia (serious criteria hospitalization and GSK medically significant), microscopic hematuria (serious criteria hospitalization), vasculitis (serious criteria hospitalization) and crescentic glomerulonephritis (serious criteria hospitalization and GSK medication significant). The patient was treated with cyclophosphamide and operations and Plasmapheresis (Nos). On an unknown date, the outcome of the anti-neutrophil cytoplasmic antibody positive vasculitis, fever, myalgia, hyperkalemia, vasculitis and crescentic glomerulonephritis were unknown and the outcome of the acute kidney injury and microscopic hematuria were recovering/resolving. The reporter considered the anti-neutrophil cytoplasmic antibody positive vasculitis, fever, myalgia, acute kidney injury, hyperkalemia, microscopic hematuria, vasculitis and crescentic glomerulonephritis to be related to Flu vaccine. Additional information was provided. This case was reported in a literature article and described the occurrence of anti-neutrophil cytoplasmic antibodies (ANCA) vasculitis in a 67-year-old male patient who was vaccinated with unspecified flu vaccine (manufacturer unknown). The patient's medical history included diabetes, hypertension and congestive heart failure. No information on patient's family history or concomitant medication was provided. On an unspecified date, the patient received unspecified flu vaccine (administration route and site unspecified; dosage unknown; batch number not provided). On an unspecified date, 3 weeks after vaccination, the patient experienced fever and myalgia. After 3 weeks, the patient presented to an emergency room with same symptoms. Subsequently, the patient was hospitalised. The patient's admission vitals and clinical examination were normal. The patient denied any systemic symptoms. Initial investigations revealed acute kidney injury with serum creatinine of 4.5, hyperkalemia of 6.1 and elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) with microscopic hematuria. Autoimmune work up was significant for elevated myeloperoxidase-anti-neutrophil cytoplasmic antibodies (MPO-ANCA) titers. Kidney histopathology showed pauci-immune vasculitis with crescentic glomerulonephritis. Subsequently, the patient was diagnosed with ANCA-vasculitis. This case has been considered serious due to hospitalisation. The patient was treated with 7 sessions of steroids, oral cyclophosphamide and plasmapheresis with improvement in renal function. The authors considered the event  ANCA-vasculitis related to unspecified flu vaccine. The authors concluded that "In our case, he received 7 sessions of plasmapheresis, oral cyclophosphamide and steroids with improvement in kidney function. It is important to recognize possible association between flu vaccine and ANCA vasculitis. Nephrologist should be vigilant for the possibility of developing renal vasculitis post flu vaccination".