Aefi

Acronym for "adverse events following immunization" (see also auto-inflammatory syndromes).

In adults, these adverse drug reactions(ADRs ) primarily relate to the influenza vaccination. They are also referred to as ASIA (autoimmune syndrome induced by adjuvant). A special form of these acquired autoimmunological syndromes has also been described as "gulf war syndrome".

To assess a suspected ADR, WHO criteria are usually used, which vary between:

• certain
• probable/likely
• possible
• unlikely
• incomplete (conditional/unclassified) and
• unassessable (unassessable/unclassifiable)

can be distinguished.

Clinically, the following symptoms are observed in AEFI: recurrent fever, myalgias, arthralgias, cognitive disorders, gastrointestinal and respiratory syndromes, exanthema (see case report below) and the (unspecific) occurrence of various autoantibodies.

A 73-year-old male patient presented with disseminated, erythematous, pruritic and pressure-dolent, nodular efflorescences on the entire integument, which correlated histologically with perivascular, interstitial dermatitis and discrete septal panniculitis. These occurred for the first time one year ago immediately after an influenza vaccination. Furthermore, there were recurrent episodes of fever and myalgia with increasing muscle weakness, weight loss and fatigue.

Laboratory chemistry revealed autoimmune hemolytic anemia (direct Coombs test positive, haptoglobin strongly elevated), pronounced leukopenia and elevated acute phase parameters such as CRP, ESR and ferritin. The blood smear and the bone marrow biopsy showed evidence of drug-related toxic damage. Both lymphoproliferative and rheumatic diseases were largely ruled out. The diagnosis of AEFI could be made in the presence of 3 major criteria (myalgia, fatigue, fever) and the medical history (previous vaccination). Treatment with oral glucocorticosteroids was initiated, which resulted in a dramatic improvement of the symptoms.

Discussion: The present case of AEFI illustrates that complex, highly chronic autoimmunologic/inflammatory clinical pictures can occur after "banal" vaccination. In addition, cutaneous and hematologic symptoms also appear to lie within the spectrum of AEFI.

1. Hehn J et al (2003) Influenza vaccination and dermatosis - coincidence or causal association. JDDG 2: 99-104
2. Israeli E (2012) Gulf War syndrome as a part of the autoimmune (autoinflammatory) syndrome induced by adjuvant (ASIA). Lupus 21:190194.