Post-vaccination myositis and myocarditis in a previously healthy male

Abstract

BackgroundThe immunological literature has been redefining clinical phenomena as hypotheses emerge regarding causal links between triggers, immunologic manifestations, and their specific inflammatory cascades. Of late, autoimmune manifestations that appear to be caused by an external adjuvant have been grouped into a complex syndrome referred to as autoimmune/inflammatory syndrome induced by adjuvants (ASIA). This syndrome may present with diverse clinical problems, which may include neurocognitive impairment, inflammatory musculoskeletal changes, and constitutional symptoms. There is evidence in the literature linking vaccines to different auto-immune manifestations. Vaccines have not traditionally been reported to trigger ASIA, although reports are emerging linking the human papilloma virus and hepatitis B vaccines to it.Case presentationWe report the first suspected case of ASIA in a previously healthy patient who received the Fluad seasonal influenza vaccine, which contains the MF59 adjuvant. He presented to hospital with profound weakness and was diagnosed with severe rhabdomyolysis. He also had elevated troponin-I and extensive cardiac investigations enabled the diagnosis of myocarditis. His infectious and rheumatologic work-ups were negative. He responded well to conservative management and did not require immune suppressive therapy.ConclusionGiven the benefits of the influenza vaccine, and the low incidence of clinically significant complications, we encourage ongoing seasonal influenza immunization. However, ongoing surveillance is required to evaluate the occurrence of rare adverse events, including ASIA.

A Young Male with Severe Myocarditis and Skeletal Muscle Myositis

“…Further literature review revealed a recently reported case of myocarditis and skeletal myositis in a 65-year-old following a seasonal influenza vaccination. Similar to our case, his myocarditis was diagnosed with cardiac MRI and an elevated troponin I, but in contrast to our case, his CK level was markedly elevated [ 17 ].…”

Analysis of the immunogenicity and bioactivities of a split influenza A/H7N9 vaccine mixed with MF59 adjuvant in BALB/c mice

“…Although vaccines must undergo strict preclinical safety evaluation before licensing. However, cases of developing serious adverse events following influenza vaccinations with adjuvant had been reported [24,25], among them the implications of adjuvants in the development of autoimmune diseases continues to receive considerable attention at recent years [25], although such adverse reaction was rare and in most cases related to myotoxic drugs use [26,27]. Some researchers even claim influenza vaccine does not produce myopathy in patients taking statins [28].…”

Acute fulminant myocarditis following influenza vaccination requiring extracorporeal membrane oxygenation

“…It is not possible to prove the hypothetical mechanism of the development of myocarditis after influenza vaccination due to its rarity as well as the associated ethical problems, but one hypothesis suggests that the immune response to compounds in the influenza vaccination and its specific inflammatory cascades may play a major role in the development of cardiovascular compromise [4,8]. It is notable that our patient received an inactivated quadrivalent influenza vaccine without adjuvant (GC Flu Quadrivalent, Green Cross).…”

“…It is notable that our patient received an inactivated quadrivalent influenza vaccine without adjuvant (GC Flu Quadrivalent, Green Cross). Previous case [4] reported that their patients received an inactivated trivalent influenza vaccine with MF59 adjuvant (Fluad, Novartis). This implies the possibility that other mechanisms also contribute to the development of cardiovascular compromise after influenza vaccination more so than the autoimmune/inflammatory syndrome induced by adjuvants.…”