Home
|
Inbox
|
Search
|
View Abstract
Rare Case of Rapidly Progressive Interstitial Lung Disease Following Adult Tetanus, Diptheria, and Pertussis (TDAP) Vaccination
Description
.abstract img { width:300px !important; height:auto; display:block; text-align:center; margin-top:10px } .abstract { overflow-x:scroll } .abstract table { width:100%; display:block; border:hidden; border-collapse: collapse; margin-top:10px } .abstract td, th { border-top: 1px solid #ddd; padding: 4px 8px; } .abstract tbody tr:nth-child(even) td { background-color: #efefef; } .abstract a { overflow-wrap: break-word; word-wrap: break-word; }
A6582 - Rare Case of Rapidly Progressive Interstitial Lung Disease Following Adult Tetanus, Diptheria, and Pertussis (TDAP) Vaccination
Author Block: N. Biru1, O. A. Shlobin2, S. Aryal2, S. D. Nathan2, L. Marinek2, C. J. Woods1, A. Brown3, c. King4; 1Pulmonary and Critical Care, Medstar Washington Hospital Center, Washington, DC, United States, 2Heart and Lung institute, Inova Fairfax Hospital, Falls Church, VA, United States, 3Heart and lung institute, Inova Fairfax Hopsital, Falls Church, VA, United States, 4Heart and Lung institute, Inova Fairfax Hopsital, Falls Chrurch, VA, United States.
Introduction
Since the advent of the tetanus, diphtheria, and pertussis (Tdap) vaccination, reports of cases of tetanus and diphtheria in the United States have dropped by ~99% and pertussis by about 80%(1). Severe side effects after Tdap include anaphylaxis, generalized urticaria, angioedema, local erythema and swelling, and neurologic complications (2). To date there is no case report of Tdap as a cause of acute pneumonitis or respiratory failure.
Presentation
A 37 year-old male with no prior medical history presented with dyspnea on exertion and worsening hypoxia for 1 month. Two months prior, the patient received the Tdap vaccine and within few days he developed myalgias, anorexia, fatigue and rash. He was evaluated by his primary care physician and was told he had a typical post-immunization response. His symptoms progressed to fever, weight loss, and shortness of breath. He presented to the emergency department (ED) a month post vaccination and was treated for pneumonia with doxycycline for 10 days without significant improvement. A week later, he returned to the ED and was admitted for work up of possible Type 3 Hypersensitivity reaction to vaccine. His work up showed positive ANA, SSA, and anti-RNP with elevated CK peaked at 701 U/L. CT chest at that time showed minimal basilar interstitial changes He was started on prednisone 80mg daily, and Levaquin 500mg daily, supplemental oxygen, and discharged home with a diagnosis of Atypical pneumonia and possible connective tissue disease. After a week, he was admitted for worsening hypoxemic respiratory failure and a repeat CT of the chest revealed diffuse ground glass opacities consistent with pneumonitis. Despite treatment with high dose steroids and five days of IVIG, the patient’s disease progressed. Due to lack of clinical response, he required venovenous extracorporeal (VV ECMO) support briefly. He underwent successful bilateral lung transplantation and is currently doing well. Pathology from native lung explants showed acute and organizing diffuse alveolar damage.
Discussion
Multiple drugs can cause pneumonitis, but vaccines have rarely been implicated. There are a few reported cases of HPV vaccine-related pneumonitis. The temporal relationship between vaccination and onset of pneumonitis and respiratory failure in this case cannot be ignored. This may represent the first reported cause of Tdap vaccine related acute pneumonitis. Alternatively, the patient may have had an underlying connective tissue disease associated ILD that exacerbated in the setting of up-regulation of his immune system following vaccine exposure.
References
1.
https://www.cdc.gov/vaccines/hcp/vis/vis-statements/tdap.html
2.
https://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM164127.pdf
Author Block: N. Biru1, O. A. Shlobin2, S. Aryal2, S. D. Nathan2, L. Marinek2, C. J. Woods1, A. Brown3, c. King4; 1Pulmonary and Critical Care, Medstar Washington Hospital Center, Washington, DC, United States, 2Heart and Lung institute, Inova Fairfax Hospital, Falls Church, VA, United States, 3Heart and lung institute, Inova Fairfax Hopsital, Falls Church, VA, United States, 4Heart and Lung institute, Inova Fairfax Hopsital, Falls Chrurch, VA, United States.
Introduction
Since the advent of the tetanus, diphtheria, and pertussis (Tdap) vaccination, reports of cases of tetanus and diphtheria in the United States have dropped by ~99% and pertussis by about 80%(1). Severe side effects after Tdap include anaphylaxis, generalized urticaria, angioedema, local erythema and swelling, and neurologic complications (2). To date there is no case report of Tdap as a cause of acute pneumonitis or respiratory failure.
Presentation
A 37 year-old male with no prior medical history presented with dyspnea on exertion and worsening hypoxia for 1 month. Two months prior, the patient received the Tdap vaccine and within few days he developed myalgias, anorexia, fatigue and rash. He was evaluated by his primary care physician and was told he had a typical post-immunization response. His symptoms progressed to fever, weight loss, and shortness of breath. He presented to the emergency department (ED) a month post vaccination and was treated for pneumonia with doxycycline for 10 days without significant improvement. A week later, he returned to the ED and was admitted for work up of possible Type 3 Hypersensitivity reaction to vaccine. His work up showed positive ANA, SSA, and anti-RNP with elevated CK peaked at 701 U/L. CT chest at that time showed minimal basilar interstitial changes He was started on prednisone 80mg daily, and Levaquin 500mg daily, supplemental oxygen, and discharged home with a diagnosis of Atypical pneumonia and possible connective tissue disease. After a week, he was admitted for worsening hypoxemic respiratory failure and a repeat CT of the chest revealed diffuse ground glass opacities consistent with pneumonitis. Despite treatment with high dose steroids and five days of IVIG, the patient’s disease progressed. Due to lack of clinical response, he required venovenous extracorporeal (VV ECMO) support briefly. He underwent successful bilateral lung transplantation and is currently doing well. Pathology from native lung explants showed acute and organizing diffuse alveolar damage.
Discussion
Multiple drugs can cause pneumonitis, but vaccines have rarely been implicated. There are a few reported cases of HPV vaccine-related pneumonitis. The temporal relationship between vaccination and onset of pneumonitis and respiratory failure in this case cannot be ignored. This may represent the first reported cause of Tdap vaccine related acute pneumonitis. Alternatively, the patient may have had an underlying connective tissue disease associated ILD that exacerbated in the setting of up-regulation of his immune system following vaccine exposure.
References
1.
https://www.cdc.gov/vaccines/hcp/vis/vis-statements/tdap.html
2.
https://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM164127.pdf
|
Home
|
Inbox
|
Search
|