Norton Benjamin, Kon Sui Phin, Perera Ranmith, Hull Richard
Department of Renal Medicine, King's College Hospital, London, UK.
Department of Histopathology, St Thomas' Hospital, Westminster Bridge Road, London, UK.
Oxf Med Case Reports. 2019 May 31;2019(5):omz031. doi: 10.1093/omcr/omz031. eCollection 2019 May.
Administration of the influenza vaccine has been associated with development of several autoimmune phenomena. We describe the case of a 72-year-old male who developed double seropositive vasculitis following seasonal influenza vaccination. On presentation, he was positive for both myeloperoxidase anti-neutrophil cytoplasmic antibody and anti-glomerular basement membrane antibody. He had stage three acute kidney injury requiring dialysis and was treated with methylprednisolone, intravenous cyclophosphamide and plasma exchange. He was also noted to have an incidental seven centimetre abdominal aortic aneurysm. He achieved remission with recovery in renal function and became haemodialysis independent. We hypothesize that the temporal relationship between influenza vaccination and double seropositive vasculitis directly triggered a systemic immune response in a susceptible patient, although a causal relationship cannot be proved. To the best of our knowledge, this is the first case of double seropositive vasculitis occurring in close temporal association with seasonal influenza vaccination.
流感疫苗的接种与多种自身免疫现象的发生有关。我们描述了一例72岁男性患者，其在接种季节性流感疫苗后发生了双阳性血管炎。就诊时，他的髓过氧化物酶抗中性粒细胞胞浆抗体和抗肾小球基底膜抗体均呈阳性。他患有三期急性肾损伤，需要进行透析，并接受了甲泼尼龙、静脉注射环磷酰胺和血浆置换治疗。还发现他伴有一个7厘米的腹主动脉瘤。他肾功能恢复，病情缓解，不再依赖血液透析。我们推测，流感疫苗接种与双阳性血管炎之间的时间关系直接触发了易感患者的全身免疫反应，尽管因果关系尚无法证实。据我们所知，这是首例与季节性流感疫苗接种在时间上密切相关的双阳性血管炎病例。
