Background: Administration of influenza vaccines has been associated with the development of autoantibodies and autoimmune rheumatic disease. Patients: 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. Conclusion: 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.

Summary Kidney transplantation (KTX) is the treatment of choice for patients with end‐stage renal disease (ESRD) due to ANCA‐associated vasculitis (AAV). Recurrent ANCA‐associated glomerulonephritis (GN) occurs after KTX and may adversely affect allograft survival. Cyclophosphamide (CYC) combined with glucocorticoids has been the cornerstone of treatment for recurrent GN. Rituximab (RTX), a B‐cell‐depleting monoclonal antibody, is approved for remission induction in AAV. We report the clinical presentation and outcomes of five KTX recipients treated with RTX for biopsy‐confirmed recurrent GN. The median age at the time of KTX was 26 years (four Caucasian, three females). All patients were in remission with four being ANCA positive at time of KTX. Recurrent GN occurred at a median of 26 months post‐KTX. All relapses were treated with RTX and glucocorticoids. Four patients achieved disease remission; the fifth patient was refractory to treatment with RTX and CYC. Follow‐up biopsies (n = 3) showed resolution of active GN in two patients and persistent active GN in one patient. RTX is an alternative to CYC for remission induction in recurrent AAV‐associated GN in KTX patients.

Background The mid‐femoral head (F50) is a common fluoroscopic target for common femoral artery (CFA) puncture during cardiac catheterization. Punctures above the inguinal ligament (marking the proximal end of CFA) increase the risk of retroperitoneal hemorrhage and are classified as high punctures. Methods We retrospectively analyzed 114 CT angiograms for the anatomic relationship of the inguinal ligament to the femoral head (FH) and inferior epigastric artery (IEA). We analyzed 114 CT angiograms and 500 femoral angiograms, for the relation of the mid‐point of CFA to F50 and F75 (the junction of upper 3/4th and lower 1/4th of FH). Results The proximal third of femoral head (F33) (−1.4 mm) and IEA nadir (−2.9 mm) were closer approximations to the inguinal ligament than the IEA origin (−12.8 mm) or cranial end of FH (−15.2 mm). The inguinal ligament correlated better with the IEA nadir than F33 (R2 = 0.49 vs. 0.001). F75 was a closer approximation for the mid‐point of the CFA than F50 (0.3 mm vs. ‐9.2 mm). Using F75 as the target for CFA puncture carried the lowest risk for non‐CFA punctures (18.6%), while using F50 had a 41.2% risk for non‐CFA punctures. F75 had an increased risk for low punctures (14.2%) but F50 had a far higher risk for high punctures (36.6%). Conclusions The nadir of IEA is the best landmark for identifying the inguinal ligament (the proximal end of CFA) and defining high punctures. F75 is a more accurate target for successful CFA puncture than F50.

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