Sex: M
Vaccine: FLUX, PPV
Symptoms: Acute kidney injury, Acute myocardial infarction, Alanine aminotransferase increased, Anion gap increased, Aspartate aminotransferase increased
Clinical narrative: Initial unsolicited report received from the literature on 08-Feb-2018. Literature Abstract: We present a 59-year-old male with history of type-1 diabetes and alcohol abuse. Patient became critically ill after a 5-day period of burning throat discomfort. On arrival patient was lethargic, in cardiogenic shockwith a blood pressure of 81/47 mmHg. Immediate diagnoses included diabetic ketoacidosis, acute renal failure, and possible septic shock. He was intubated, resuscitated with intravenous fluids, maintained on three inotropic agents, and given empiric wide spectrum antibiotics. An ECG showed a new ST elevation MI and an echocardiogram showed severe LV dysfunction. Cardiac catheterization showed clean coronaries. With appropriate treatment patient recovered 10 days later. This case involves a patient 59-year-old male patient, who was vaccinated with INFLUENZA VACCINE and PNEUMOCOCCAL VACCINE (batch number, expiry date, dose, route and site of administration were not reported) on an unknown date in 2001. Patient's past medical history was significant for uncontrolled type-1 diabetes mellitus and alcohol abuse. He was recently hospitalization for a left big toe infection treated with surgical debridement and intravenous antibiotics. He had no known drug allergy. Patient's medications included Insulin, Lisinopril, Lorazepam, Acetaminophen and Aspirin. On an unknown date, following the vaccination, patient had felt lethargic and bought to ER (emergency room), acute renal failure, rhabdomyolysis, shock liver, disseminated intravascular coagulation, Multi organ failure, Pericarditis and cardiogenic shock. This is a case of Lack of efficacy leading to influenza type a myocarditis. On an unknown date, after the vaccination, patient also had sick with 5 days of burning throat discomfort his initial blood pressure was 81/47 mmHg, heart rate 86 bpm, temperature of 97.5F (36.4C), SaO2 96% (FiO2 21%). Blood sugar level was greater than 1000 with an anion-gap up to 40, consistent with diabetic ketoacidosis. Serum K (potassium) levels was 6.9 mEq/L. Chest x-ray revealed mild diffuse interstitial prominence. Twelve-lead ECG (ecocardogram) revealed sinus rhythm, peaked T waves and no acute ischemic changes. While still in the ED (emergency department), his clinical condition deteriorated rapidly. He became unresponsive with labored breathing. Blood pressure dropped to 58/34, heart rate to 38 bpm, and pH of 6.65. The patient was intubated, resuscitated with normal saline and norepinephrine infusion before transfer to the ICU. During the first 24 hours, cardiac troponin-I bumped from 0.33 to 30.0 ng/mL with peak greater than 50, and CPK (creatin phosphor kinase) from 298 to 18,000 U/Lwith peak of 33,265. Cardiac ultrasound revealed global hypokinesis with a LV ejection fraction of 20%. ECG (Electrocardiogram) showed ST elevation in leads I and AVL, inferior and lateral ST depression, and mild ST elevation in leads aVR and V1. Urgent cardiac catheterization revealed normal coronaries, and LVEF of 20%. An intra-aortic balloon pump was inserted for hemodynamic support. An echocardiogram done a day later showed mild improvement in LV function (EF=25%). Given patient's reported flu-like symptoms, nasopharyngeal swab obtained on day three of admission tested positive for influenza A antigen (suspected influenza infection), and negative for influenza B antigen. Oseltamivir 75mg twice daily was administered. Four days later, repeat nasopharyngeal swab tested negative for influenza A antigen. Hospitalization date was not reported. It was also a case of vaccination failure. The case was also consider as serious because of life threatening events. Patient's other laboratory and other corrective treatment was not reported. Patient recovered from the events. Documents held by sender: none. Sender's Comments: The time to onset was not known. the patient had a medical history of type 1 diabetes and alcohol abuse. Time to onset, vaccination details like name or lot number, start date of events were not provided. Lab tests providing the immune status of the patient were also not reported. the events could be related to the patients pre existing medical condition. Additional information regarding progression of diabetes related ailments should be acquired. Nasal swab showed presence of influenza a virus antigen which suggest a possible vaccination failure. Additional information regarding the patients medical condition since 2001 post vaccination should be requested along with latency and name or lot number of the vaccine should be requested to further assess the case.