Sex: M
Vaccine: PPV
Symptoms: Bronchiectasis, Computerised tomogram thorax abnormal, Condition aggravated, Eosinophil count normal, Fractional exhaled nitric oxide normal
Clinical narrative: pneumococcal antibody levels increased to 10 of 23 after vaccination with polyvalent pneumococcal vaccine / partially protective pneumococcal antibody levels after vaccination; This literature marketed report has been received from the authors of a published literature article, titled as stated below and refers to a 56-year-old male was referred for consideration of anti-IL-5 biologic therapy for prednisone-dependent asthma. The diagnosis was established as a child based on a history of wheezy bronchitis and later confirmed as an adult with greater than 15% bronchodilator reversibility. The patient was a 7-pack-year ex-smoker and had a history of chronic rhinosinusitis with nasal polyposis before polypectomy at age 31. The patient experienced numerous asthma exacerbations, one of which required hospitalization for concomitant pneumonia; each was treated with prednisone and oral antibiotic. The exacerbations occurred despite high-dose inhaled corticosteroids, long-acting B-agonist and long-acting muscarinic antagonist therapies. He had severe airflow with obstruction with an FEV of 1.02 L (29% predicted) and an forced vital capacity (FVC) of 3.47 L (76% predicted). Chest computed tomography (CT) showed mild lingular bronchiectasis and the highest blood eosinophil count was normal at 30/uL. Fractional exhaled nitric oxide (FeNO) was normal on multiple occasions at about 15 (<25 parts per billion) and the sputum cell count showed neutrophilic inflammation with a total cell count of 60.9 x 10^6 (<9.7 x 10^6 cells/g), 91% of which were neutrophils (upper limit normal = 65%). Additionally, investigations into secondary cause of neutrophilic asthma exacerbations revealed a likely a pathogenic heterozygous cystic fibrosis transmembrane conductance regulator (CFTR) mutation with normal sweat test and consistent HGG with igG 341 mg/dL, igA 41 mg/dL, igE level was normal at 25 IU/mL and igM 10 mg/dL; lymphocyte immune phenotyping showed low switched memory B cells. The patient had no history of aeroallergen sensitization and there was no family history of atopy or immunodeficiency.  The patient's pneumococcal antibody levels were partially protective (four of 23 protective levels) before he was vaccinated with pneumococcal vaccine, polyvalent (23-valent) (PNEUMOVAX23) injection (dose, strength, lot #, expiry date, anatomical location and route of administration were not provided) as prophylaxis on an unknown date. After vaccination with pneumococcal vaccine, polyvalent (23-valent) (PNEUMOVAX23), the patient's pneumococcal antibody levels increased to 10 of 23. (Antibody test abnormal). Because of persistent high grade glioma (HGG), partially protective pneumococcal antibody levels after vaccination and recurrent infections, intravenous immunoglobulin therapy (IVIG) was started at a dose of 0.4g/kg monthly to prevent infectious exacerbations. The outcome of the event antibody test abnormal was not reported.  The reporter considered antibody test abnormal to be related to pneumococcal vaccine, polyvalent (23-valent) (PNEUMOVAX23).  A copy of the published article is attached as further documentation of the patient's experience.  This is one of 2 reports derived from the same literature article (cross referenced with MARRS # 2208USA000300).  Literature Report: Sender's Comments:  US-009507513-2208USA000300: