Sex: F
Vaccine: FLU4
Symptoms: Pulmonary function test abnormal, Rash vesicular, Toxic epidermal necrolysis, Walking distance test abnormal
Clinical narrative: This case was reported in a literature article and described the occurrence of toxic epidermal necrolysis in a 31-year-old female patient who received Influenza vaccine Quadrivalent. On an unknown date, the patient received Influenza vaccine Quadrivalent (intramuscular). On an unknown date, unknown after receiving Influenza vaccine Quadrivalent, the patient experienced toxic epidermal necrolysis (serious criteria hospitalization and GSK medically significant), blistery rash (serious criteria hospitalization), obliterative bronchiolitis (serious criteria GSK medically significant), bronchiectasis (serious criteria GSK medically significant), obliterative bronchitis, dyspnoea, exertional, airways obstruction, bronchial wall thickening and cough nonproductive. The patient was treated with Albuterol, prednisone and Bronchodilator. On an unknown date, the outcome of the toxic epidermal necrolysis, blistery rash, obliterative bronchiolitis, bronchiectasis, obliterative bronchitis, airways obstruction, bronchial wall thickening and cough nonproductive were unknown and the outcome of the dyspnoea exertional was recovering/resolving. It was unknown if the reporter considered the toxic epidermal necrolysis, blistery rash, obliterative bronchiolitis, bronchiectasis, obliterative bronchitis, dyspnoea exertional, airways obstruction, bronchial wall thickening and cough nonproductive to be related to Influenza vaccine Quadrivalent. Additional information was provided. This case was reported in a literature article and described the occurrence of Toxic Epidermal Necrolysis (TEN) and obliterative bronchiolitis (OB) in 31-year-old female patient who was vaccinated with unspecified influenza vaccine (manufacturer unknown). No information on patient's medical or family history or concurrent condition or concomitant medication was provided. On an unspecified date, the patient received unspecified influenza vaccine (administration route and site unspecified; dosages unknown; batch number not provided) intramuscularly. Age of vaccination was not provided. On an unspecified date, an unknown period after vaccination, the patient was admitted to the medical intensive care unit with a blistering rash to her face, neck, chest, back, abdomen, arms, lips, anus, and genitals. She underwent skin biopsy which was consistent with toxic epidermal necrolysis (TEN). She required endotracheal intubation and mechanical ventilator support and was successfully extubated after 14 days. Flexible bronchoscopy did not reveal any abnormalities. She was discharged home without requiring supplemental oxygen. 5 months after her episode of TEN, the patient was presented to a primary care visit with progressive dyspnoea on exertion and non-productive cough. Prior to developing TEN, she had no pulmonary diagnoses or complaints. Pulmonary function tests (PFT) were obtained and showed a forced expiratory volume (FEV1)/forced vital capacity (FVC) 85% with FEV1 0.79L (39%) and no bronchodilator response. She was prescribed an albuterol inhaler without improvement in her symptoms. She was referred for a pulmonary evaluation. Further testing with repeat PFTs revealed persistent non-reversible airflow obstruction. High resolution CT scan (HRCT) of the chest demonstrated multifocal ground glass densities, multilobar bronchiectasis, and air trapping without tracheomalacia. She did not desaturate on six-minute walk test. She was subsequently started on oral prednisone for treatment of OB with improvement in her dyspnoea but no improvement in airflow obstruction. This case has been considered serious due to hospitalisation. The author did not comment on relationship between the event of Toxic Epidermal Necrolysis (TEN) and obliterative bronchiolitis (OB) and unspecified influenza vaccine. The author stated, our patient developed respiratory complaints 5 months post TEN. Pulmonary complications in the chronic phase of TEN are rare and most of the them are secondary to obliterative bronchiolitis. PFTs reveal non-reversible airflow obstruction and HRCT demonstrated bronchiectasis, thickened bronchial walls, and signs of air trapping. No effective therapy has been determined for the treatment of OB after TEN and lung transplant referral is often required. This condition is associated with significant disease burden. Early awareness and referral to lung transplant is essential until future therapies are discovered. Imaging: High resolution computed tomography demonstrating bilateral central bronchiectasis.