Antineutrophil Cytoplasmic Antibody Vasculitis Associated with Influenza Vaccination

Abstract

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.

Randomized trial investigating the safety and efficacy of influenza vaccination in patients with antineutrophil cytoplasmic antibody‐associated vasculitis

“…There are case reports of otherwise healthy people developing de novo autoimmune diseases following influenza vaccination . Similarly, the onset of AAV, in otherwise healthy individuals, has been described following influenza immunization . A large population study of healthy individuals has found no association between influenza vaccination and the development of autoimmune disease .…”

MPO-ANCA associated vasculitis with mononeuritis multiplex following influenza vaccination

“…Since the patient showed overlapping sets of clinical features it was difficult to diagnose the exact subtype of AAV [ 10 , 11 ]. Currently, a handful of AAV cases have been reported in temporal association with influenza vaccination [ 12 – 17 ]. Recently, The Brighton Collaboration Vasculitis Working Group published a systematic literature review on adverse events following immunization (AEFI) suggesting an association between influenza vaccination and vasculitis, however no evidence is found to confirm this association yet [ 18 ].…”

Vaccines, adjuvants and autoimmunity

“…That being said, influenza vaccinations showed increased risk of autoimmune responses suggestive of ASIA [132], vasculitis [133] and APS [134] among others.…”