流感疫苗接种后伴多发性单神经炎的MPO-ANCA相关性血管炎
MPO-ANCA associated vasculitis with mononeuritis multiplex following influenza vaccination.
作者信息
Eindhoven Stefanie, Levels Jolien, Huisman Margriet, de Winter Koos Ruizeveld, Dalm Virgil, Alwani Rehmat
机构信息
Department of Internal Medicine, IJsselland Hospital, Capelle aan den IJssel, The Netherlands.
Department of Internal Medicine, Room F104, IJsselland Hospital, P.O. Box 690, 2900 AR Capelle aan den IJssel, The Netherlands.
出版信息
Allergy Asthma Clin Immunol. 2017 Dec 13;13:49. doi: 10.1186/s13223-017-0222-9. eCollection 2017.
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.
背景
尽管流感疫苗总体上安全有效，但在过去几年中，接种疫苗后报告了多种自身免疫现象，如格林-巴利综合征、类风湿性关节炎、寻常型天疱疮、银屑病、巨细胞动脉炎以及抗中性粒细胞胞浆抗体（ANCA）相关血管炎（AAV）。
病例报告
我们描述了一名67岁男性的病例，该患者在接种季节性流感疫苗后出现了伴有肾脏受累和多发性单神经炎的髓过氧化物酶-ANCA相关血管炎。他最初接受了静脉注射环磷酰胺和大剂量泼尼松龙治疗，随后接受了硫唑嘌呤和泼尼松龙组成的维持治疗。
结论
我们推测，季节性流感疫苗接种在一名易感患者中引发了全身免疫反应，导致出现伴有肾脏受累和血管炎性神经病变的AAV。一般来说，季节性流感疫苗接种被认为是安全的，然而，临床医生应意识到这种罕见现象。
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