title: Acute disseminated encephalomyelitis with severe neurological outcomes following virosomal seasonal influenza vaccine.
abstract: Acute disseminated encephalomyelitis (ADEM) is an inflammatory, usually monophasic, immune mediate, demyelinating disease of the central nervous system which involves the white matter. ADEM is more frequent in children and usually occurs after viral infections, but may follow vaccinations, bacterial infections, or may occur without previous events. Only 5% of cases of ADEM are preceded by vaccination within one month prior to symptoms onset. The diagnosis of ADEM requires both multifocal involvement and encephalopathy and specific demyelinating lesions of white matter. Overall prognosis of ADEM patients is often favorable, with full recovery reported in 23% to 100% of patients from pediatric cohorts, and more severe outcome in adult patients. We describe the first case of ADEM occurred few days after administration of virosomal seasonal influenza vaccine. The patient, a 59-year-old caucasic man with unremarkable past medical history presented at admission decreased alertness, 10 days after flu vaccination. During the 2 days following hospitalization, his clinical conditions deteriorated with drowsiness and fever until coma. The magnetic resonance imaging of the brain showed multiple and symmetrical white matter lesions in both cerebellar and cerebral hemispheres, suggesting demyelinating disease with inflammatory activity, compatible with ADEM. The patient was treated with high dose of steroids and intravenous immunoglobulin with relevant sequelae and severe neurological outcomes.
authors.affiliation: a Department of Health Sciences; Vaccines and Clinical Trials Unit; University of Genoa; Genoa Italy.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Alicino
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Infante
authors.forename: Ilaria
authors.initials: I
authors.lastname: Gandoglia
authors.forename: Nadia
authors.initials: N
authors.lastname: Miolo
authors.forename: Gian Luigi
authors.initials: GL
authors.lastname: Mancardi
authors.forename: Simona
authors.initials: S
authors.lastname: Zappettini
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Capello
authors.forename: Andrea
authors.initials: A
authors.lastname: Orsi
authors.forename: Tiziano
authors.initials: T
authors.lastname: Tamburini
authors.forename: Marina
authors.initials: M
authors.lastname: Grandis
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D004673:Encephalomyelitis, Acute Disseminated / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D007252:Influenza Vaccines / Q000008:administration & dosage / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis*; D011859:Radiography; D013256:Steroids / Q000627:therapeutic use; D022721:Vaccines, Virosome / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D000893:Anti-Inflammatory Agents; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D007252:Influenza Vaccines; D013256:Steroids; D022721:Vaccines, Virosome
keywords: ADEM; acute disseminated encephalomyelitis; adverse event; influenza vaccination; virosomal vaccine