title: Can immunization precipitate connective tissue disease? Report of five cases of systemic lupus erythematosus and review of the literature.
abstract: OBJECTIVE
  To report a series of five patients who developed systemic lupus erythematosus (SLE) after immunization and review the literature on vaccine-associated connective tissue diseases and the theoretical mechanisms that could explain such an association.
  
  
  METHODS
  Uncontrolled retrospective analysis of cases identified sporadically over 7 years at three centers.
  
  
  RESULTS
  In our series of 5 patients, symptoms of SLE developed within 2 to 3 weeks after secondary immunization. All patients met American College of Rheumatology (ACR) criteria for the diagnosis of SLE. In most patients, symptoms have been persistent.
  
  
  CONCLUSIONS
  Although a coincidental association between vaccination and the onset of SLE cannot be excluded, the temporal relationship with the development of symptoms makes it immunologically plausible that vaccination triggered systemic autoimmunity in these rare cases. We propose that epidemiological studies be performed to examine this potential association in more detail to quantitate the risk and identify possible genetic risk factors.
authors.affiliation: Rheumatology Service, Brooke Army Medical Center, and Veterans Affairs Medical Center and Department of Medicine, University of Iowa, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Older
authors.forename: D F
authors.initials: DF
authors.lastname: Battafarano
authors.forename: R J
authors.initials: RJ
authors.lastname: Enzenauer
authors.forename: A M
authors.initials: AM
authors.lastname: Krieg
mesh_terms: D000328:Adult; D015551:Autoimmunity / Q000187:drug effects; D005260:Female; D006801:Humans; D007117:Immunization, Secondary / Q000009:adverse effects*; D008180:Lupus Erythematosus, Systemic / Q000209:etiology* / Q000276:immunology; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D014611:Vaccination / Q000009:adverse effects*; D014612:Vaccines / Q000009:adverse effects*
chemical_list: D014612:Vaccines