title: Pancreatitis after human papillomavirus vaccination: a matter of molecular mimicry.
abstract: A 20-year-old man developed severe abdominal pain 1 week after being vaccinated with the first dose of quadrivalent human papillomavirus (HPV) vaccine (Gardasil®). Despite ongoing symptoms of nausea and pain, he received the second dose of the vaccine. Only 10 days later, laboratory results revealed significantly elevated pancreatic enzymes, and with concomitant abdominal pain and vomiting, he was diagnosed with acute pancreatitis. This case of acute pancreatitis after HPV vaccination is not a novel entity. Although confirming the relationship between pancreatitis and vaccine is challenging, some factors suggest a possible link, including the positive re-challenge upon repeated exposure to the vaccine, HPV vaccine as probable causal relationship to other autoimmune diseases and a probable mechanism of molecular mimicry. In conjunction with aluminum adjuvant, the induction of immunity through molecular mimicry may potentially culminate in production of cytotoxic autoantibodies with a particular affinity for pancreatic acinar cells.
authors.affiliation: The Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, 52621, Tel-Hashomer, Israel.
authors.forename: Mojca
authors.initials: M
authors.lastname: Bizjak
authors.affiliation: The Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, 52621, Tel-Hashomer, Israel.
authors.forename: Or
authors.initials: O
authors.lastname: Bruck
authors.affiliation: Department of Rheumatology, University Medical Centre, Ljubljana, Slovenia.
authors.forename: Sonja
authors.initials: S
authors.lastname: Praprotnik
authors.affiliation: The Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, 52621, Tel-Hashomer, Israel.|Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel.|Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.
authors.forename: Shani
authors.initials: S
authors.lastname: Dahan
authors.affiliation: The Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, 52621, Tel-Hashomer, Israel. shoenfel@post.tau.ac.il.|Incumbent of the Laura Schwarz-Kipp Chair for Research of Autoimmune Diseases, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel. shoenfel@post.tau.ac.il.
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Shoenfeld
mesh_terms: D000328:Adult; D006801:Humans; D008297:Male; D018716:Molecular Mimicry; D010195:Pancreatitis / Q000209:etiology*; D053918:Papillomavirus Vaccines / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines
keywords: Adjuvant; Autoimmunity; Human papillomavirus; Molecular mimicry; Pancreatitis; Vaccine