FROM INFLUENZA TO STROKE: A MOSAIC OF MECHANISMS LINKING THE VIRUS, THE VACCINE AND THE DISEASE.
- Vânia Borba, Portugal
Abstract
Background and Aims
A 62-year-old female presented with low-grade fever, malaise and pronounced fatigue few days after she received the influenza vaccine for the first time. The symptoms persisted for five weeks until she was hospitalized with severe headaches associated with nausea, vomiting and left-side hemiparesis. The computed tomography (CT) revealed an extensive intracranial hemorrhage. Curiously, no cause of intracranial hemorrhage was identified, and the patient did not have previous history of illness or medication intake predisposing to hemorrhagic stroke.
Methods
Case report and literature review.
Results
Although confirming the relationship between the stroke and the vaccine might be challenging, some aspects raise great suspicion, including the absence of risk factors on her past history, no causes for intracranial bleeding identified on the CT scan, and finally the occurrence of the event five weeks after vaccination, preceded by an illness status suggestive of an exaggerated systemic inflammatory response.
Conclusions
A considerable number of autoimmune diseases such as Guillain-Barré syndrome, systemic lupus erythematosus, rheumatoid arthritis, multiple sclerosis, pemphigus vulgaris and more commonly, vasculitis may occur as adverse events following influenza infection and vaccination by mechanisms that remain undetermined. In this structured review, we describe a case report and summarize the current evidence on the association between influenza and cerebral vasculitis, focusing on molecular mimicry as the underlying ties which link the virus, the vaccine and the disease.