Lytic Lesion in the Proximal Humerus After a Flu Shot

Abstract

Case: There has been a recent campaign to vaccinate patients in an effort to prevent widespread flu pandemic. Although the complication rate after vaccine is low, there have been reports of Guillain-Barré syndrome and shoulder injury related to vaccine administration (SIRVA). In this case presentation, we discuss a patient who developed a large lytic lesion in the proximal humerus after a deeply administered flu shot. Conclusions: SIRVA is a rare cause of shoulder pain after injections, but one that progresses and often necessitates operative management. Clinicians should be wary of persistent shoulder pain after a flu shot.

Progressive Monoarticular Inflammatory Arthritis Following Influenza Vaccination

“…To our knowledge, there has been only one other documented case of refractory shoulder dysfunction with progressive erosive changes on MRI and CT following influenza vaccination. 11 In that case, the patient did not respond well to conservative management, which included 2 ultrasound-guided intraarticular steroid injections and subsequent arthroscopic biopsy and debridement, with sampling of the posterior humeral head erosion. Analysis showed inflammatory destruction of the articular cartilage and bone, and marrow replacement by both fibrous and fibromyxoid tissue.…”

“…Subsequently, there have been a few published case reports and small series for a total of 25 cases describing the MRI findings of prolonged postvaccination shoulder injury. 5,[9][10][11][12][13] Fourteen of the 25 cases documented the MRI findings of bursitis, 5,12,[14][15][16][17][18][19] and 10 cases demonstrated bone marrow edema in the humeral head, 5,[10][11][12]14,16,[18][19][20] 8 of which followed influenza vaccination. Only 4 previous cases have demonstrated bone erosion on MRI after vaccination, 10,11,19,20 3 of which followed influenza vaccination.…”

Ultrasonic aspiration for vaccination-related shoulder dysfunction

“…(B) Axial T1-weighted MRI 2 months after an influenza vaccination showing edema in the infraspinatus tendon and lytic lesions in the posterior humerus, which enlarged into a single lesion over the next 8 months. Following surgical debridement of the lesion, the patient's pain resolved (from Erickson et al [14]).…”

Lesão de Ombro após a Vacinação: Uma Revisão Sistemática

“…The secondary outcome was to evaluated the etiology of the proposed injury mechanism with regard to the most commonly suggested reasons for a SIRVA (needle length, vaccination technique and autoimmune response). 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 We hypothesize that unique diagnostic findings will be identified and generalizable clinical results will be demonstrated, and we further hypothesize that a critical analysis of the factors associated with the proposed mechanism will provide guidance for avoiding additional shoulder injuries.…”

“…6 The structures reportedly involved have included the rotator cuff, labrum, capsule, bursa, deltoid muscle, and this included diagnoses of bursitis, rotator cuff tears, adhesive capsulitis, chondral injury, nerve injury and infection. 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 The most common mechanism proposed is overpenetration of the deltoid muscle leading to injury either from a mechanical injury and/or from an immune response to the vaccine and/or adjuvants, and these events have frequently been correlated with an incorrect injection technique. 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 Thus, the primary outcome of this review was to identify unique features of SIRVA and the clinical results.…”