gms | German Medical Science

45. Kongress der Deutschen Gesellschaft für Rheumatologie, 31. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie, 27. Jahrestagung der Gesellschaft für Kinder- und Jugendrheumatologie

06.09. - 09.09.2017, Stuttgart

Local and systemic reaction to meningococcal vaccination in a patient with Cryopyrin-associated Periodic Syndrome

Meeting Abstract

  • Jasmin Kümmerle-Deschner - Universitätskinderklinik Tuebingen, Rheumatologie, Tübingen
  • Sandra Hansmann - Universitätsklinikum Tübingen, Klinik für Kinder- und Jugendmedizin, Ambulanz für Autoimmunerkrankungen, Tübingen
  • Ulrich A. Walker - Universitäts-Poliklinik, Felix-Platter Spital, Basel, Schweiz

Deutsche Gesellschaft für Rheumatologie. Deutsche Gesellschaft für Orthopädische Rheumatologie. Gesellschaft für Kinder- und Jugendrheumatologie. 45. Kongress der Deutschen Gesellschaft für Rheumatologie (DGRh), 31. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie (DGORh), 27. Jahrestagung der Gesellschaft für Kinder- und Jugendrheumatologie (GKJR). Stuttgart, 06.-09.09.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocFA.16

doi: 10.3205/17dgrh025, urn:nbn:de:0183-17dgrh0256

Published: September 4, 2017

© 2017 Kümmerle-Deschner et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Background: Among other immunizations, vaccinations against pneumococci, meningococci, tetanus and influenza, are recommended for patients with Cryopyrin-Associated Periodic Syndromes (CAPS) when treated with IL-1 inhibitors. Severe local and systemic reactions after pneumococcal vaccination have been reported in CAPS patients [1]. Here we describe the first case of local and systemic reaction in a CAPS patient following meningococcal vaccination.

Case presentation: A 6 year-old boy was symptomatic since age one with recurrent fever episodes, urticaria-like rash, musculoskeletal symptoms and severe fatigue. Disease flares were associated with elevated inflammatory markers (SAA, CRP, ESR). CAPS was diagnosed at the age of six years, although no mutation was found. Prior to the treatment with IL-1-inhibitors, meningococcal vaccination (Nimenrix®) was applied. A severe painful local reaction with redness, swelling of the arm, and warmth appeared on the day of vaccination. Two days after the injection, fever (39.8°C), headache, arthralgia, myalgia, nausea, diarrhea and generalized urticaria were noted. Symptoms resolved five days after the vaccination.

Previously he had been vaccinated against tetanus/diphtheria and influenza antigens without adverse events. However vaccination against pneumococci (Prevenar®) had also induced a severe local reaction but less systemic features compared to the meningococcal vaccination.

Discussion: While susceptibility for reactions following pneumococcal vaccination is well documented in CAPS patients [1], reactions after meningococcal vaccinations have not been reported so far. In accordance with previous observations of a high percentage of vaccine reactions after pneumococcal vaccination [1], our patient also displayed reactions after pneumococcal vaccination but not after tetanus/diphtheria and influenza vaccination.

Conclusion: Pneumococcal and potentially also meningococcal vaccines, may trigger severe local and systemic inflammation in CAPS patients. Clinicians must balance potential benefits of immunization against safety concerns.


References

1.
Walker UA, et al. Arthritis Rheumatol. 2016 Feb;68(2):516-20.