Initial unsolicited report received from the literature (Abstract article) on 24-Apr-2019. This case is linked to cases 2019SA114647 and 2019SA114646 (same literature article). The following is the abstract from the article - Objectives: A variety of environmental risk factors are capable of triggering the onset of rheumatic disorders. Vaccines stand next to antibiotics as a nineteenth-century medical breakthrough impacting the human evolution and survival. Evidently, an age-old process of conferring immunity without active infection, practiced in civilizations, introduced and advocated in modern medicine at the time of renaissance by prominent physicians. Vaccines tend to stimulate both the humoral and cellular immunity depending on the type of antigenic stimulation. As with any other medical-intervention, even vaccines sometimes result in adverse events. Vaccine-related side effects are increasing exponentially with higher availability, awareness, and reporting. Methods: Standard dose, inactivated, trivalent influenza vaccine was administered to two middle-aged healthy women, one was being treated for palindromic rheumatism. Another young woman on her late twenties also received an unspecified influenza vaccine. The first two developed rheumatoid arthritis, and the third developed systemic lupus erythematosus, initially manifesting with lupus neuritis presenting as classical fortification spectra permeated by the diversity of different colors. All in close proximity to their immunizations. All three disease processes remained chronic, requiring continuous standard treatment. We discuss the above case details along with the summary of the available vaccine side-effects related studies. It is still unclear regarding the risk autoimmune disorders with vaccinations, while few studies support the norm, others refute, still, the data is insufficient to draw a conclusion, given the rarity and under-recognition of these outcomes and inability to separately observed incidence rates in the susceptible population apart from the general population. Results: The vaccine-induced autoimmune disease may have atypical presentation when compared to the idiopathic origin counterpart. This might direct towards slightly altered pathologic mechanisms directed at vaccine-related phenomena. The incidence of autoimmune reactions to influenza vaccines is currently unknown, but it can no longer be assumed that a coincidental (i.e., unrelated) association exists between immunization and the onset of RA and SLE. Few studies show the increased odds of developing arthritis with MMR vaccine, Sjogren's syndrome, reactive arthritis with influenza, psoriatic arthritis with Rubella vaccine and severely neurologic disorders post Rabies vaccination. A causative link was seen between influenza vaccine in mid-seventies with Guillain Barre syndrome, forcing the discontinuation of the vaccine. These may be related to the molecular mimicry or adjuvant related mechanisms, which are yet to be fully unveiled. Conclusions: Although no strong evidence exists to contraindicate vaccinations, even in patients with existing autoimmune conditions, though the immune response if not as strong as in normal individuals, the benefits granted for routine vaccination. There might be a special group of the population with more predisposition to vaccine-related adverse effects, and only with more epidemiologic data and physician awareness and reporting, we might be able to find the at-risk groups and lower the incidence similar to analyzing HLA-B-5801 status in the high-risk population before prescribing allopurinol for gout, we might be running special panels for those at-risk communities before vaccinating. This case involves Adult female patient (late twenties) who experienced systemic lupus erythematosus, while she received vaccine INFLUENZA VACCINE. Information on the batch number was requested. The patient's past medical history, medical treatment(s), vaccination(s) and family history were not provided. On an unknown date, the patient received a dose of suspect INFLUENZA VACCINE produced by unknown manufacturer lot number not reported via unknown route in unknown administration site. On an unknown date, the patient developed a serious systemic lupus erythematosus following the administration of INFLUENZA VACCINE. This event was assessed as medically significant. This disease processes remain chronic, requiring continuous standard treatment. (Other relevant tests included no lab data). Final diagnosis was systemic lupus erythematosus. Other corrective treatment was not reported. The outcome of the event was Unknown. The incidence of autoimmune reactions to influenza vaccines is currently unknown, but it can no longer be assumed that a coincidental (i.e., unrelated) association exists between immunization and the onset of RA and SLE. Sender's Comments: This literature article reports about adult female patient (late twenties) who experienced systemic lupus erythematosus after vaccination with INFLUENZA VACCINE produced by unknown manufacturer. The time to onset is unknown. There is no information regarding patients medical history, immune status, condition at the time of vaccination, nor are any lab/radiological results provided refuting alternate causes. Based upon the reported information, the role of the vaccine cannot be assessed.