Antineutrophil cytoplasmic antibody vasculitis associated with influenza vaccination.
BACKGROUND
Administration of influenza vaccines has been associated with the development of autoantibodies and autoimmune rheumatic disease.


METHODS
We discuss 2 patients who developed antineutrophil cytoplasmic antibody-associated vasculitis (AAV) in temporal association with influenza immunization. AAV was diagnosed 2 and 4 weeks after immunization in these patients. Both patients had renal involvement with one requiring dialysis. Both patients were treated with cyclophosphamide and corticosteroids, and plasmapheresis was added to the immunosuppressive regimen in one patient with dialysis-dependent renal failure. Both patients achieved disease remission. The patient with initial dialysis-dependent renal failure reached end-stage renal disease. There are 6 previous cases of AAV in the literature described in temporal association with administration of influenza vaccines.


CONCLUSIONS
A causal role of vaccines in AAV cannot be confirmed with these case reports. The temporality suggests that the influenza vaccine may be a triggering factor for induction of vasculitis in predisposed individuals. We review the literature on reported cases of AAV following influenza vaccine administration and discuss possible mechanisms for influenza vaccine-associated AAV.
Department of Medicine, Sinai Hospital of Baltimore, Baltimore, Md., USA.
Tanu
T
Duggal
Paul
P
Segal
Megha
M
Shah
Naima
N
Carter-Monroe
Pradeep
P
Manoharan
Duvuru
D
Geetha
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000209:etiology* / Q000276:immunology*; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000276:immunology*; D001706:Biopsy; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007252:Influenza Vaccines / Q000009:adverse effects*; D007251:Influenza, Human / Q000517:prevention & control; D007676:Kidney Failure, Chronic / Q000150:complications / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D006435:Renal Dialysis / Q000379:methods; D013997:Time Factors
D000305:Adrenal Cortex Hormones; D019268:Antibodies, Antineutrophil Cytoplasmic; D007166:Immunosuppressive Agents; D007252:Influenza Vaccines; D003520:Cyclophosphamide