Influenza virus vaccine
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Systemic juvenile idiopathic arthritis relapse in a child: case report A 3-year-old girl with systemic juvenile idiopathic arthritis (sJIA) experienced relapse of her disease following administration of influenza vaccination. The girl’s sJIA was maintained on a treatment regimen of tocilizumab and prednisolone and had been in long-term remission for 7 months. She received an 0.2mL SC injection of inactivated influenza vaccine [dosage not stated] in her left upper arm. She subsequently developed pain and limitation of motion of her left arm 7 days later. Laboratory tests revealed an elevated WBC count alongside elevated levels of matrix metalloprotease-3 (MMP-3), interleukin-6 (IL-6) and interleukin-18 (IL-18). A CT scan of her left shoulder revealed synovitis with effusion. Pulse therapy with methylprednisolone was initiated. Methotrexate was initiated 9 days after the vaccination. Subsequently, the girl’s clinical symptoms improved. A second 0.2mL SC injection of inactivated influenza vaccine [dosage not stated] was administered 4 weeks after the first injection. She subsequently developed pain and swelling of her left ankle joint 7 days later. Laboratory tests again showed elevated levels of MMP-3, IL-6 and IL-18. A MRI of her left ankle revealed synovitis with effusion. Her symptoms rapidly improved with methylprednisolone pulse therapy. At last observation she had been in longterm remission for 17 months with ongoing tocilizumab and prednisolone therapy. Author comment: "[I]n our case, s-JIA relapses occurred after both injections of influenza vaccine. In some cases, s-JIA may not be completely controlled and could be exacerbated by a trigger such as influenza vaccination." Shimizu M, et al. Relapse of systemic juvenile idiopathic arthritis after influenza vaccination in a patient receiving tocilizumab. Clinical and Vaccine Immunology 19: 1700-1702, No. 10, Oct 2012. Available from: URL: http://dx.doi.org/10.1128/ 803081024 CVI.00309-12 - Japan
0114-9954/10/1432-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 15 Dec 2012 No. 1432
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