Age: 28.0
Sex: M
Vaccine: FLUX, PPV, FLUX, PPV
Symptoms: Cellulitis, Inflammation, Injection site erythema, Injection site oedema, Injection site warmth
Clinical narrative: Initial report was retrieved via a search of scientific literature on 14 May 2014. This case contains information for 1 of 5 patients whose clinical data were provided. Information regarding the other 4 patients were captured in case numbers 2014SA063511, 2014SA063512, 2014SA063513 and 2014SA063514. Verbatim from the abstract: "Background: Fever, leukocytosis, and large local reactions following the PS23 have been described only in isolated case reported in the adult literature. Such atypical reactions can pose difficulty to providers when determining management. Patients experiencing this noninfectious reaction may receive unnecessary treatment if the diagnosis of robust inflammatory response to the PS23 vaccine is not considered. Observations: This is a clinical case series of 5 adult patients who received the influenza and PS23 vaccines and experienced a cellulitis-like reaction, fever, and leukocytosis in the days following vaccination. Four of the five patients received the influenza and PS23 vaccines in the same arm. The patient who received the vaccines in opposite arm had the local findings in the arm that received the PS23 vaccine. All 5 patients sought care and 4 were admitted to the hospital for observation or treatment with intravenous antibiotics. Conclusions: This case series highlights potential side effects of the PS23 vaccine that are not well described in the adult literature. Antibiotics were not helpful in treating these patients' local and systemic symptoms. Patients with histories consistent with that highlighted in this case series may avoid antibiotics and hospitalization if their providers recognize these symptoms as a noninfectious reaction to the PS23 vaccine. Regarding this case which involves a 28 year old male patient with a history of asplenia had received on an unspecified date the following vaccines: an arm injection of Influenza vaccine (manufacturer, lot number, route and anatomical side of administration not reported) and an in the same arm an injection of 23-valent pneumococcal polysaccharide vaccine (manufacturer, lot number, route and anatomical side of administration not reported) and within one day of vaccination developed a fever of 104.5 degrees Fahrenheit and vomiting. The patient also developed local erythema, edema and warmth at the site of injection. The patient had significant leukocytosis with a white blood cell (WBC) of 29.7 K/uL. C-reactive protein and erythrocyte sedimentation rate (ESR) was not checked. The patient was admitted to hospital and treated with antibiotics in hospital and post discharge. Within 5 to 7 days the patient experienced improvement in the skin findings and resolution of the systemic symptoms. The patient had received PS23 pneumococcal vaccine (manufacturer unknown) prior to this reaction for the indication of asplenia. The date of prior vaccination was not available as it occurred prior to the patient's enrollment in the employers healthcare system. The patient had not received any subsequent pneumococcal vaccines. Outcome was recovered for systemic symptoms and unknown for local reaction. Documents held by sender: none.