Influenza A virus vaccine-H1N1
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Exacerbation of idiopathic pulmonary fibrosis: case report A man developed acute exacerbation of idiopathic pulmonary fibrosis (IPF) after receiving the influenza A virus vaccine-H1N1. A 57-year-old man was diagnosed with IPF in September 2008. No worsening of his preexisting abnormal opacity was noted following seasonal influenza vaccination in November 2009. In early December 2009, he received the influenza A virus vaccine-H1N1 [dosage and route not stated]. Two days later, he developed dyspnoea on effort and a fever. On admission, he had a pulse rate of 104 beats/minute and a body temperature of 38.8°C; fine crackles were audible in the bilateral lung bases. Laboratory findings revealed a WBC count of 10 800/mm3, 82.9% neutrophils and 10.9% lymphocytes; his levels of CRP, LDH and KL-6 were 15.71 mg/dL, 336 IU/L and 2072 U/mL, respectively. Hypoxia and hypocarbia were evident on blood gas analysis. Chest x-ray demonstrated features of diffuse infiltrates in both lung fields; new diffuse bilateral ground-glass opacities and honeycombing with basal and peripheral predominance were notable on chest CT. He was diagnosed with acute exacerbation of IPF. On admission day 2, mechanical ventilation was applied for progression of respiratory failure. The man was treated with methylprednisolone and cyclophosphamide pulse therapy, antibacterials, sivelestat and haemoperfusion. His PiO2 /FiO2 ratio improved from 168 to 403 following intensive treatment, and mechanical ventilation was withdrawn on day 16. Chest x-ray and CT revealed improvement in the ground-glass opacities. He received prednisolone and ciclosporin as maintenance therapy. Long-term oxygen therapy was required, despite symptom improvement. Author comment: "In the present case, influenza A (H1N1) vaccination was the most likely cause of acute exacerbation." Umeda Y, et al. Acute exacerbation of idiopathic pulmonary fibrosis after pandemic influenza a (H1N1) vaccination. Internal Medicine 49: 2333-2336, No. 21, 2010. Available from: URL: http://dx.doi.org/10.2169/internalmedicine.49.3890 803046592 - Japan
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Reactions 8 Jan 2011 No. 1333
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