Influenza Vaccine-related Subacromial/Subdeltoid Bursitis: A Case Report

Abstract

Serious side effects of vaccinations are not common, though rare complications can occur. We present a case of one such uncommon side effect, influenza vaccine-related subacromial/subdeltoid bursitis. A 72-year-old female presented with severe shoulder pain following influenza vaccination. The pain persisted for up to two months despite conservative measures, and MRI demonstrated moderate subacromial/subdeltoid bursitis. Vaccine-related shoulder dysfunction includes a range of pathology, from osteonecrosis to bursitis, which will be reviewed in this report. Recognition of infrequent vaccine-related musculoskeletal pathology is important to prevent delay of diagnosis.

Keywords: Influenza; autoimmune/inflammatory syndrome induced by adjuvants; bursitis; myositis; shoulder injury related to vaccine administration; vaccine; vaccine-related bursitis; vaccine-related shoulder dysfunction.

Figure 1

72 year-old female with right shoulder pain following influenza vaccination, secondary to vaccine-related subacromial/subdeltoid bursitis. FINDINGS: Initial imaging included a) AP and b) axillary view radiographs. Radiographs showed no acute fracture or dislocation. There was a 9 mm ossification (arrow) noted at the anterior aspect of the joint, which was interpreted as an ossified chondral body within the bicipital groove. The acromioclavicular and glenohumeral joint spaces were maintained.

Figure 2

72 year-old female with right shoulder pain following influenza vaccine, secondary to vaccine-related subacromial/subdeltoid bursitis. FINDINGS: 3 Tesla MRI without contrast show images that are somewhat limited by motion artifact and the patient’s request for early termination of the exam. However, fluid distention of the subacromial/subdeltoid bursa is distinctly visualized on the available sequences. A) Axial and b) coronal T2 FS sequence shows subacromial/subdeltoid bursal fluid (arrowheads). Technique: 3T Axial T2 with fat saturation (TR 5145, TE 80); 3T Coronal T2 with fat saturation (TR 4662, TE 80).

Figure 3

72 year-old female with right shoulder pain following influenza vaccine, secondary to vaccine-related subacromial/subdeltoid burisits. FINDINGS: Sonographic evaluation of the right shoulder (a–f) with a linear GE ML6-15 transducer set at 11 to 15 MHz shows a) small amount of residual fluid in the subacromial/subdeltoid bursa (arrowheads). B) Intact supraspinatus tendon at the footprint. C) Small partial thickness, articular sided tear in the infraspinatus tendon at the footprint (long arrow). D) A very small partial thickness intra-substance tear is noted within the subscapularis tendon (short arrows). No full thickness rotator cuff tear is noted. E–F) Redemonstrated ossific body in the bicipital groove. Small amount of fluid and hyperemia around the bicipital groove.