De Simone C, Caldarola G, D’agostino M et al.
Catholic University of the Sacred Heart, Rome, Italy.
Clin Exp Dermatol 2008;33:718–20.
Editor’s note: This case report describes a 47-year-old man with known pemphigus vulgaris that was exacerbated on two separate occasions shortly after the administration of an influenza vaccination. These exacerbations occurred while the man was receiving maintenance therapy with prednisone; he required an increase in the prednisone dosage and, during the second exacerbation, the addition of mycophenolate mofetil to control the disease. Although, given the relapsing nature of pemphigus vulgaris, the reactivations after the influenza vaccinations in this patient could have been a coincidence, they are suspicious. A few other cases of pemphigus developing or reactivating after a viral or bacterial vaccination have been described, including one other case after an influenza vaccination (
Int J Dermatol 2000;39:800). Flare-ups of other autoimmune diseases, such as lupus erythematosus and rheumatoid arthritis, have also been described after influenza vaccination, especially in patients with insufficient disease control. According to the authors, vaccination in these patients should be considered only after a careful risk–benefit assessment. A patient history should be taken to identify individuals with an inadequate therapeutic response, who possibly have a higher risk of reactivation. Nevertheless, the incidence of reactivation of pemphigus after an influenza vaccination is not mentioned in this paper and, according to the rare case reports, seems to be very low.