Sex: F
Vaccine: FLU4
Symptoms: Dystonia, Haematoma, Muscle spasms, Muscle tightness, Platelet count normal
Clinical narrative: This case was reported in a literature article and described the occurrence of hematoma in a female patient who received Influenza vaccine Quadrivalent unspecified season. The patient's past medical history included dystonia (idiopathic dystonia) and anaphylactic reaction (anaphylactic allergy to platelet transfusion in the past). Concurrent medical conditions included Hermansky-Pudlak syndrome. On an unknown date, the patient received Influenza vaccine Quadrivalent unspecified season at an unknown dose. On an unknown date, unknown after receiving Influenza vaccine Quadrivalent unspecified season, the patient experienced hematoma (serious criteria hospitalization), dystonia (serious criteria hospitalization) and spasms (serious criteria hospitalization). The patient was treated with Glucocorticoids, BENADRYL and Platelets. On an unknown date, the outcome of the hematoma, dystonia and spasms were recovered/resolved. The reporter considered the hematoma, dystonia and spasms to be related to Influenza vaccine Quadrivalent unspecified season. Additional information was provided. This case was reported in a literature article and described the occurrence of expanding hematoma and dystonia in a female of unspecified age who was vaccinated with unspecified influenza vaccine (manufacturer unknown). The patient had a history of Hermansky-Pudlak syndrome and idiopathic dystonia. Her dystonic episodes were characterised by sudden sensation of tightness/spasm in various parts of her body. The patient had history of anaphylactic allergy to platelet transfusion in the past. No information on patient's family history or concomitant medication or concurrent condition was provided. On an unspecified date, the patient received unspecified influenza vaccine (administration route and site unspecified; dosages unknown; batch number not provided). The age of vaccination was not provided. On an unspecified date, an unknown period after vaccination, the patient developed hematoma. Subsequently, the patient presented with hematoma that had expanded over the course of 5 days. The patient had normal platelet count of 337. Upon admission, the patient had sudden sensation of tightness/spasm that began in her neck which radiated into her lower back, sacrum and into bilateral upper extremities. The patient described spasms as a pulling sensation after which her body "collapsed" on account of the sensation of tightness and becomes "folded" and rates them as 10/10 in severity. The patient's dystonia resolved spontaneously and required extensive pre-treatment with glucocorticoids and BENADRYL for transfusion of 2 units of platelets to halt expansion of hematoma. The patient tolerated transfusion of platelets well and no complication were observed on this occasion. This case has been considered serious due to hospitalisation. The authors did not comment on the relationship between the event of expanding hematoma and dystonia and unspecified influenza vaccine. The authors concluded "Hermansky-Pudlak syndrome is an autosomal recessive disorder caused by mutations in 1 of 10 known genes responsible to packaging and formation of lysosomes including those of melanosomes and platelet-dense granules resulting in multisystem manifestation of disease. The syndrome is characterised albinism, platelet dysfunction and pulmonary fibrosis. Two subtypes of this syndrome are also known to have immune deficiency likely related to dysfunction of cytotoxic-T cells and natural killer (NK) cells. Platelet dysfunction is thought to be related to dysfunction of specialized storage compartments within platelets which are called lysosome-related organelles. We here present a summary of recent advances in our understanding of this syndrome in hopes to contribute to an effort towards improvements in management or a cure".