Dados do Trabalho

Título

Yellow fever vaccine followed by aseptic meningitis: case series

Introdução/Fundamentos

Yellow fever vaccine (YFV) has been receiving an increasing relevance since the recommended areas have expanded. Therefore, related side effects are more often recognized1. YFV has a neurotropic effect and is associated with encephalitis, autoimmune neurological disease, transverse myelitis and aseptic meningitis, which occur less than 1 per 1.000.000 vaccine applications.

Objetivos

The present cases aim to encourage clinicians to consider YFV as a potential trigger of aseptic meningitis.

Caso

Case 1: A 30-year-old woman presented with headache, fever, prostration and myalgia for seven days. She was previously healthy and only in use of oral contraceptive. She had taken YFV 20 days before the presentation. Clinical and neurologic exams were normal. Blood analysis was normal, except for platelets of 109x109/L. Screening tests for dengue, leptospirosis, HIV, hepatitis A, B and C, EBV and syphilis were negative. Liquor analysis showed: glucose 61mg/dl (serum glucose 84mg/dl); protein 77mg/dl; total cytology 192cells/mm³ (14 red cells, 95% lymphocytes, 1% neutrophils, 4% monocyte/macrophages); India ink stain, syphilis, bacteria and fungus cultures, AFB and HSV molecular panel were negative. She progressed with clinical improvement after eight days of hospitalization.
Case 2: A 29-year-old woman presented with severe frontal headache, phono and photophobia, nausea, vomiting and fever for seven days. She was in use of amoxicillin for five days since rhinosinusitis had been considered. She was previously healthy and had received YFV 30 days before the presentation. Neurologic exam was normal, except for the presence of meningeal signs (Brudzinski and Kernig). Blood analysis was normal. Screening tests for syphilis, hepatitis B and C and HIV were negative. Liquor analysis showed: glucose 52mg/dl; total protein 85,6mg/dl; total cytology 96cells/mm³ (3 red cells, 90% lymphocyte, 5% neutrophils, 5% monocyte/macrophage); negative tests for India ink stain, bacteria and fungus cultures, AFB and HSV molecular panel. She received supportive treatment and progressed with clinical improvement.

Conclusões/Considerações finais

A straight association between YFV and the meningitis cases presented cannot be confirmed, however temporal relation and antigen’s neurotropic effect make it plausible. Once YFV side effect is assumed as a potential cause of aseptic meningitis, inappropriate therapy may be avoided and properly support should be offered, usually leading to a good prognosis.

Palavras-chave

Área

Clínica Médica