MPO-ANCA associated vasculitis with mononeuritis multiplex following influenza vaccination

• Main Authors: Stefanie Eindhoven, Jolien Levels, Margriet Huisman, Koos Ruizeveld de Winter, Virgil Dalm, Rehmat Alwani
• Format: Article
• Language: English
• Published: BMC 2017-12-01
• Series: Allergy, Asthma & Clinical Immunology
• Subjects: Influenza vaccination; Anti-neutrophil cytoplasmic antibody (ANCA); Vasculitis
• Online Access: http://link.springer.com/article/10.1186/s13223-017-0222-9

Abstract Background Although influenza vaccines are generally safe and effective, a variety of autoimmune phenomena have been reported after vaccination over the past years, such as Guillain–Barre syndrome, rheumatoid arthritis, pemphigus vulgaris, psoriasis, giant cell arteritis and anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV). Case report We describe the case of a 67-year old man who presented with a myeloperoxidase-ANCA associated vasculitis with renal involvement and mononeuritis multiplex after seasonal influenza vaccination. He was initially treated with intravenous cyclophosphamide and high-dose prednisolone followed by maintenance treatment consisting of azathioprine and prednisolone. Conclusion We hypothesize that seasonal influenza vaccination triggered a systemic immune response in a susceptible patient to develop AAV with renal involvement and vasculitic neuropathy. In general, seasonal influenza vaccinations are considered to be safe, however, clinicians should be aware of this rare phenomenon.