Influenza vaccine-induced rhabdomyolysis leading to acute renal transplant dysfunction

Raman, Kris S.; Chandrasekar, T. S.; Reeve, Roy; Roberts, Mustimbo; Kalra, Philip A.

doi:10.1093/ndt/gfi195

Cited by 24 publications

(31 citation statements)

References 5 publications

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“…Similar to our case, there are two reports of patients who were taking a statin drug that developed myalgias and progressive weakness 24 hours post influenza vaccination with subsequent rhabdomyolysis and acute kidney injury [3,4]. Additionally, another case of muscle aches and weakness leading to rhabdomyolysis one week post influenza vaccination has been described in a 57 year old renal transplant patient who was also taking simvastatin and cyclosporin A [5]. Our patient was not on similar confounding drugs, and in particular, no statin.…”

Section: Discussionsupporting

confidence: 85%

Post-Vaccination Myositis and Myocarditis in a Previously Healthy Male

Cheng¹,

Kozoriz²,

Ahmadi³

et al. 2015

Intern Med

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Rhabdomyolysis is the breakdown of muscle cells leading to the release of cellular constituents such as electrolytes, enzymes and myoglobin. There is a broad differential diagnosis for this condition. In this report we describe a 65 year old male who presented with weakness, rhabdomyolysis, and acute kidney injury five days after receiving the seasonal flu vaccine. Laboratory investigations showed elevated creatine kinase and troponin-I, and extensive cardiac investigations yielded a diagnosis of myocarditis. The cause of his clinical picture is explored in this case report. Case PresentationA 65 year old previously healthy male presented to hospital with profound weakness. Five days before admission he had received the seasonal influenza vaccine, comprised of one influenza A H1/N1 virus, one influenza A H3/N2 virus and one influenza B virus. Two days later, he developed bilateral crampy leg pain, muscle tenderness and weakness that progressed until the day of admission. He became unable to weight-bear and was brought to the emergency department by his wife. He denied symptoms of headaches, paresthesias, arthralgias or any new rash. An infectious review of systems was unremarkable and he did not have any constitutional symptoms. He was not taking any medications or herbal preparations prior to admission, and did not use recreational drugs.On physical exam his vitals were: P 92, BP 124/84, RR 20, T 36.7°C and his O 2 saturation was 100% on room air. His neurological exam was significant for 4/5 strength in the hip flexors, hip extensors, hip abductors and hip adductors. He could not stand from the sitting position without the aid of his arms. The muscles of his arms and legs were also tender. His cardiac examination revealed a jugular venous pressure (JVP) two cm above the sternal angle. His apical beat was normal. Auscultation revealed a normal S1 and S2 without any extra sounds, murmurs or rubs. His respiratory exam revealed mild crackles in the left lower lung zone. The rest of the examination was unremarkable.His blood counts were WBC 11 × 99/L, hemoglobin 123 g/L (MCV 83 fL) and platelets 134 × 109/L. Electrolytes included sodium 126 mmol/L, potassium 3.2 mmol/L, chloride 101 mmol/L, bicarbonate 17 mmol/L, phosphate 0.75 mmol/L and magnesium 0.97 mmol/L. Other investigations showed urea 11.6 mM/L, creatinine 157 mM/L, creatine kinase (CK) 7,736 U/L (normal <150 U/L) and troponin 9.44 g/L (normal <0.2 g/L). His ethanol level was negative. His EKG was normal sinus rhythm with a right bundle branch block, without ischemic features. A chest X-ray and contrast enhanced computed tomography scan of the chest revealed a hiatus hernia, a left lower lobe consolidation, and no evidence of pulmonary embolism (Figure 1).Acute rhabdomyolysis was diagnosed and the patient received four liters of fluid over the ensuing 24 hours. During volume resuscitation he developed pulmonary crackles, his JVP increased to 5 cm above the sternal angle and his O 2 saturation decreased to 90% on room air. He was placed on supplemen...

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Section: Discussionsupporting

confidence: 85%

Post-Vaccination Myositis and Myocarditis in a Previously Healthy Male

Cheng¹,

Kozoriz²,

Ahmadi³

et al. 2015

Intern Med

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“…The safety profile of influenza vaccination does not appear significantly different from healthy controls in the published literature. However, one case of Guillain-Barré syndrome in a liver transplant recipient and another case of rhabdomyolysis leading to renal failure and kidney retransplantation after influenza vaccination have been reported (51,52).…”

Section: Effects Of Vaccination Including Allograft Dysfunctionmentioning

confidence: 99%

Influenza Vaccination in the Organ Transplant Recipient: Review and Summary Recommendations

Kumar

Blumberg

Danziger‐Isakov

et al. 2011

American Journal of Transplantation

156

164

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Influenza virus causes a spectrum of illness in transplant recipients with a high rate of lower respiratory disease. Seasonal influenza vaccination is an important public health measure recommended for transplant recipients and their close contacts. Vaccine has been shown to be safe and generally well tolerated in both adult and pediatric transplant recipients. However, responses to vaccine are variable and are dependent on various factors including time from transplantation and specific immunosuppressive medication. Seasonal influenza vaccine has demonstrated safety and no conclusive evidence exists for a link between vaccination and allograft dysfunction. Annually updated trivalent inactivated influenza vaccines have been available and routinely used for several decades, although newer influenza vaccination formulations including high-dose vaccine, adjuvanted vaccine, quadrivalent inactivated vaccine and vaccine by intradermal delivery system are now available or will be available in the near future. Safety and immunogenicity data of these new formulations in transplant recipients requires investigation. In this document, we review the current state of knowledge on influenza vaccines in transplant recipients and make recommendations on the use of vaccine in both adult and pediatric organ transplant recipients.

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“…The clinicians face a challenge when they recognise the rhabdomyolysis. Fibrate therapy and influenza vaccine both were reported as a possible cause of rhabdomyloysis previously (3)(4)(5). But it's obvious that a few reports have been done.…”

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confidence: 99%