Reactions 1704, p201 - 2 Jun 2018 Influenza A virus vaccine H1N1/ influenza virus vaccine Henoch-Schonlein purpura nephritis: case report A 16-year-old boy developed Henoch-Schonlein purpura (HSP) nephritis (HSPN) following the vaccination with influenza virus vaccine and influenza-A virus vaccine H1N1 [pandemic influenza H1N1 vaccine; routes and dosages not stated; not all durations of treatments to reaction onsets stated]. The boy received a dose of influenza A virus vaccine H1N1, on 16 November 2009 and another influenza virus vaccine, on 13 January 2010. Fifteen days after the second vaccine, he developed cutaneous purpura on his lower legs. His physical examination showed symmetric distribution of palpable purpura on his upper and lower limbs and bright erythematous swelling on the skin that did not blanch on compression. Laboratory investigations showed a platelet count of 182 × 10 /L and monocytes 13.0%. Urinalysis revealed traces of protein (3+) and occult blood (2+) containing a RBC count of 236.4 /µL. He was diagnosed with Henoch Schonlein purpura (HSP). He was hospitalised with HSPN, on 25 February 2010. A coagulation tests showed a prothrombin time of 12.1 seconds, activated partial prothrombin time of 28.8 seconds, thrombin time of 20.2 seconds, INR values of 1.01 and fibrinogen level of 2.44 g/L. Further investigation revealed an IgE level of 298 g/l and a 24-hour urine protein level of 0.15g. The boy was treated with antihistamines and symptomatic therapy for renal protection. One week after the treatment, his purpura had disappeared symptomatically, and he was discharged on 06 March 2010. He was initiated on prednisone for renal management, on 15 July 2010. He was hospitalised again due to nausea, headache, fever and pink urine, on 24 May 2011. Laboratory investigations revealed a 24-hour urinary protein level of 0.40g and traces of protein (4+) on urine dipstick. Later, pathology findings of renal biopsy sample revealed seven cellular crescents in 42 glomeruli. Immunofluorescence histology was positive for IgA. He was again diagnosed with HSPN and treated with methylprednisolone and methotrexate (stoss therapy). Later, he was discharged home. However, he was hospitalised again on 07 March 2012, 07 September 2012 and 07 December 2012 to receive stoss therapy for HSPN. During this time, his urinary protein levels were negative or found in traces. He presented for upper respiratory tract infection, on 02 December 2013. Laboratory investigations revealed protein (1+) and occult blood (2+) in the urine. He was treated with traditional Chinese medication. Author comment: "This case of Henoch-Schonlein purpura may have been due to the [influenza-virus-vaccine]." "Although the mechanism behind the development of HSP among those who had received influenza vaccination is unknown, a possible link between influenza vaccination and autoimmunity has been suggested." Liu JY, et al. Henoch-Schonlein purpura nephritis following influenza vaccination: a case report and review of the literature. SouthEast Asian Journal of Tropical Medicine and Public Health 47: 945-950, No. 5, Sep 2016. Available from: URL: http://www.tm.mahidol.ac.th/seameo/2016-47-5/07-685327-945.pdf - China 803322763 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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