Sex: F
Vaccine: TD
Symptoms: Synovitis, Therapy non-responder, Visual analogue scale, White blood cell count abnormal
Clinical narrative: refractory Shoulder Injury Related to Vaccine Administration; developed increasing left shoulder pain/worsening shoulder pain; pain was worse with shoulder movement t and was worse at night with preserved range of motion/Pain was worse with overhead activities including putting on a shirt; nonspecific synovitis; fever; chills; generalized malaise; septic arthritis; Cutibacterium acnes infection; weakness with overhead activities and most forms of upper body; This serious case was reported in a literature article and described the occurrence of shoulder injury related to vaccine administration in a 27-year-old female patient who received DTP (A or W not known) (Diphtheria tetanus pertussis (A or W not known)) for prophylaxis. Literature Reference.  In JUL-2020, the patient received Diphtheria tetanus pertussis (A or W not known) (left deltoid). On an unknown date, an unknown time after receiving Diphtheria tetanus pertussis (A or W not known), the patient experienced shoulder injury related to vaccine administration (Verbatim: refractory Shoulder Injury Related to Vaccine Administration) (serious criteria clinically significant/intervention required), shoulder pain (Verbatim: developed increasing left shoulder pain/worsening shoulder pain) (serious criteria clinically significant/intervention required), pain upon movement (Verbatim: pain was worse with shoulder movement t and was worse at night with preserved range of motion/Pain was worse with overhead activities including putting on a shirt) (serious criteria clinically significant/intervention required), synovitis (Verbatim: nonspecific synovitis) (serious criteria clinically significant/intervention required), fever (Verbatim: fever), chills (Verbatim: chills), general malaise (Verbatim: generalized malaise), septic arthritis (Verbatim: septic arthritis) (serious criteria GSK medically significant and clinically significant/intervention required), cutibacterium acnes infection (Verbatim: Cutibacterium acnes infection) and weakness (Verbatim: weakness with overhead activities and most forms of upper body). The patient was treated with opioids {nos} (Opioids), non-drug therapy (Physical Therapy) and antibiotics nos (Antibiotics Therapy (Unknown)). The outcome of the shoulder injury related to vaccine administration, pain upon movement, synovitis, fever, chills, general malaise, septic arthritis and cutibacterium acnes infection were resolving and the outcome of the shoulder pain was not resolved and the outcome of the weakness was not reported.   The reporter considered the shoulder injury related to vaccine administration, shoulder pain, pain upon movement, synovitis, fever, chills, general malaise, septic arthritis, cutibacterium acnes infection and weakness to be related to Diphtheria tetanus pertussis (A or W not known).     The company considered the shoulder injury related to vaccine administration, shoulder pain, pain upon movement, synovitis, fever, chills, general malaise, septic arthritis, cutibacterium acnes infection and weakness to be related to Diphtheria tetanus pertussis (A or W not known).   Additional Information: Receipt Date: 7-Aug-2023 This case corresponds to case-2 reported in this literature article. The patient received a Tetanus, Diphtheria, and Pertussis vaccine to the left shoulder in July 2020 at a primary care office. The patient had a small body habitus (height 157.48 centimeters, weight 56.7 kilograms, calculated Basal metabolic index 22.9). The patient developed increasing left shoulder pain starting 12-24 hours following the injection. The patient reported the pain was worse with shoulder movement and was worse at night with preserved range of motion. Pain was worse with overhead activities including putting on a shirt. The patient first sought medical care for the left shoulder 8 days following the injection. Single assessment number evaluation (SANE) score at initial presentation was 10/100. The site of vaccine administration was described as high and posterior. Due to atypical presentation and failure to respond to initial conservative measures, a magnetic resonance imaging (MRI) was obtained 14 days after injection and was concerning for nonspecific synovitis. The patient was then prescribed opioids and physical therapy without clinical improvement. Eight weeks after the vaccine injection, the patient had worsening shoulder pain rated 10/10 Visual Analogue Scale (VAS) and developed concomitant fevers and chills with generalized malaise. A glenohumeral joint aspiration was performed and the white blood cell count was consistent with septic arthritis more than 60,000. The following day, the patient underwent arthroscopic irrigation and debridement of the shoulder. Fluid aspiration from the glenohumeral joint and tissue biopsies from the glenohumeral joint obtained with a meniscal punch were positive for Cutibacterium acnes. Arthroscopic extensive debridement of the shoulder was performed with synovectomy performed with an arthroscopic shaver of the glenohumeral joint and debridement of the subacromial space. Postoperatively, the infectious disease service was consulted and recommended 6 weeks of intravenous antibiotic therapy. Physical therapy was initiated without restriction to facilitate return of shoulder motion and strength. The patient noted relief approximately 8 days after surgery. At final follow-up approximately 14 months after inoculation and 12 months after arthroscopic debridement, the patient reported a SANE score of 75/100 with complaints of persistent pain (4/10 VAS with activity) and weakness with overhead activities and most forms of upper body exercise. The article corresponding to this case is not available for regulatory submission due to copyright restriction.