Advertisement

Immunologic Research

, Volume 65, Issue 1, pp 164–167 | Cite as

Pancreatitis after human papillomavirus vaccination: a matter of molecular mimicry

  • Mojca Bizjak
  • Or Bruck
  • Sonja Praprotnik
  • Shani Dahan
  • Yehuda Shoenfeld
Environment and Autoimmunity

Abstract

A 20-year-old man developed severe abdominal pain 1 week after being vaccinated with the first dose of quadrivalent human papillomavirus (HPV) vaccine (Gardasil®). Despite ongoing symptoms of nausea and pain, he received the second dose of the vaccine. Only 10 days later, laboratory results revealed significantly elevated pancreatic enzymes, and with concomitant abdominal pain and vomiting, he was diagnosed with acute pancreatitis. This case of acute pancreatitis after HPV vaccination is not a novel entity. Although confirming the relationship between pancreatitis and vaccine is challenging, some factors suggest a possible link, including the positive re-challenge upon repeated exposure to the vaccine, HPV vaccine as probable causal relationship to other autoimmune diseases and a probable mechanism of molecular mimicry. In conjunction with aluminum adjuvant, the induction of immunity through molecular mimicry may potentially culminate in production of cytotoxic autoantibodies with a particular affinity for pancreatic acinar cells.

Keywords

Human papillomavirus Vaccine Pancreatitis Molecular mimicry Autoimmunity Adjuvant 

Notes

Compliance with ethical standards

Conflict of interest

Y. Shoenfeld has served as an expert witness in cases involving adverse vaccine reaction in the no-fault USA National Vaccine Injury Compensation Program. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

References

  1. 1.
    Nesvaderani M, Eslick GD, Cox MR. Acute pancreatitis: update on management. Med J Aust. 2015;202(8):420–3.CrossRefPubMedGoogle Scholar
  2. 2.
    Tenner S, Baillie J, DeWitt J, Vege SS. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013;108(9):1400–15.CrossRefPubMedGoogle Scholar
  3. 3.
    Das A, Chang D, Biankin AV, Merrett ND. Pancreatitis following human papillomavirus vaccination. Med J Aust. 2008;189(3):178.PubMedGoogle Scholar
  4. 4.
    Talukdar R, Clemens M, Vege SS. Moderately severe acute pancreatitis: prospective validation of this new subgroup of acute pancreatitis. Pancreas. 2012;41(2):306–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Sanchez-Castanon M, de las Heras-Castano G, Lopez-Hoyos M. Autoimmune pancreatitis: an underdiagnosed autoimmune disease with clinical, imaging and serological features. Autoimmun Rev. 2010;9(4):237–40.CrossRefPubMedGoogle Scholar
  6. 6.
    Okazaki K, Tomiyama T, Mitsuyama T, Sumimoto K, Uchida K. Diagnosis and classification of autoimmune pancreatitis. Autoimmun Rev. 2014;13(4–5):451–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Brito-Zeron P, Ramos-Casals M, Bosch X, Stone JH. The clinical spectrum of IgG4-related disease. Autoimmun Rev. 2014;13(12):1203–10.CrossRefPubMedGoogle Scholar
  8. 8.
    Islam AD, Selmi C, Datta-Mitra A, Sonu R, Chen M, Gershwin ME, et al. The changing faces of IgG4-related disease: clinical manifestations and pathogenesis. Autoimmun Rev. 2015;14(10):914–22.CrossRefPubMedGoogle Scholar
  9. 9.
    Cirocchi R, Santoro A, Corsi A, Ronca P, Desiderio J, Barberini F, et al. Autoimmune pancreatitis: a case of difficult diagnosis. Prz Gastroenterol. 2015;10(1):51–3.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Haviv YS, Sharkia M, Galun E, Safadi R. Pancreatitis following hepatitis A vaccination. Eur J Med Res. 2000;5(5):229–30.PubMedGoogle Scholar
  11. 11.
    Bogdanos DP, Smith H, Ma Y, Baum H, Mieli-Vergani G, Vergani D. A study of molecular mimicry and immunological cross-reactivity between hepatitis B surface antigen and myelin mimics. Clin Dev Immunol. 2005;12(3):217–24.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Williams OM, Hart KW, Wang EC, Gelder CM. Analysis of CD4(+) T-cell responses to human papillomavirus (HPV) type 11 L1 in healthy adults reveals a high degree of responsiveness and cross-reactivity with other HPV types. J Virol. 2002;76(15):7418–29.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Kanth VR, Reddy DN. Genetics of acute and chronic pancreatitis: an update. World J Gastrointest Pathophysiol. 2014;5(4):427–37.CrossRefGoogle Scholar
  14. 14.
    Pearce SH, Wooding C, Davies M, Tollefsen SE, Whyte MP, Thakker RV. Calcium-sensing receptor mutations in familial hypocalciuric hypercalcaemia with recurrent pancreatitis. Clin Endocrinol. 1996;45(6):675–80.CrossRefGoogle Scholar
  15. 15.
    Steele JC, Roberts S, Rookes SM, Gallimore PH. Detection of CD4(+)- and CD8(+)-T-cell responses to human papillomavirus type 1 antigens expressed at various stages of the virus life cycle by using an enzyme-linked immunospot assay of gamma interferon release. J Virol. 2002;76(12):6027–36.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Cason J, Kambo PK, Jewers RJ, Chrystie IL, Best JM. Mapping of linear B cell epitopes on capsid proteins of bovine papillomavirus: identification of three external type-restricted epitopes. J Gen Virol. 1993;74(Pt 12):2669–77.CrossRefPubMedGoogle Scholar
  17. 17.
    Jin CX, Hayakawa T, Ko SB, Ishiguro H, Kitagawa M. Pancreatic stone protein/regenerating protein family in pancreatic and gastrointestinal diseases. Intern Med. 2011;50(15):1507–16.CrossRefPubMedGoogle Scholar
  18. 18.
    Israeli E, Agmon-Levin N, Blank M, Shoenfeld Y. Adjuvants and autoimmunity. Lupus. 2009;18(13):1217–25.CrossRefPubMedGoogle Scholar
  19. 19.
    Pellegrino P, Clementi E, Radice S. On vaccine’s adjuvants and autoimmunity: current evidence and future perspectives. Autoimmun Rev. 2015;14(10):880–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Shlomovitz E, Davies W, Cairns E, Brintnell WC, Goldszmidt M, Dresser GK. Severe necrotizing pancreatitis following combined hepatitis A and B vaccination. CMAJ. 2007;176(3):339–42.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Janigan DT, Nevalainen TJ, MacAulay MA, Vethamany VG. Foreign serum-induced pancreatitis in mice. I. A new model of acute pancreatitis. Lab Invest. 1975;33(6):591–607.PubMedGoogle Scholar
  22. 22.
    Shoenfeld Y, Aron-Maor A. Vaccination and autoimmunity-’vaccinosis’: a dangerous liaison? J Autoimmun. 2000;14(1):1–10.CrossRefPubMedGoogle Scholar
  23. 23.
    Blank M, Israeli E, Shoenfeld Y. When APS (Hughes syndrome) met the autoimmune/inflammatory syndrome induced by adjuvants (ASIA). Lupus. 2012;21(7):711–4.CrossRefPubMedGoogle Scholar
  24. 24.
    Sah RP, Chari ST. Recent developments in steroid-responsive pancreatitides (autoimmune pancreatitis). Curr Opin Gastroenterol. 2015;31(5):387–94.CrossRefGoogle Scholar
  25. 25.
    Shimosegawa T, Chari ST, Frulloni L, Kamisawa T, Kawa S, Mino-Kenudson M, et al. International consensus diagnostic criteria for autoimmune pancreatitis: guidelines of the International Association of Pancreatology. Pancreas. 2011;40(3):352–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Perricone C, Colafrancesco S, Mazor RD, Soriano A, Agmon-Levin N, Shoenfeld Y. Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) 2013: unveiling the pathogenic, clinical and diagnostic aspects. J Autoimmun. 2013;47:1–16.CrossRefPubMedGoogle Scholar
  27. 27.
    Slade BA, Leidel L, Vellozzi C, Woo EJ, Hua W, Sutherland A, et al. Postlicensure safety surveillance for quadrivalent human papillomavirus recombinant vaccine. JAMA. 2009;302(7):750–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Gatto M, Agmon-Levin N, Soriano A, Manna R, Maoz-Segal R, Kivity S, et al. Human papillomavirus vaccine and systemic lupus erythematosus. Clin Rheumatol. 2013;32(9):1301–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Tomljenovic L, Shaw CA. Death after quadrivalent human papillomavirus (HPV) vaccination: causal or coincidental? Pharm Reg Affairs 2012;S12:001.Google Scholar
  30. 30.
    Soldevilla HF, Briones SF, Navarra SV. Systemic lupus erythematosus following HPV immunization or infection? Lupus. 2012;21(2):158–61.CrossRefPubMedGoogle Scholar
  31. 31.
    Pellegrino P, Carnovale C, Pozzi M, Antoniazzi S, Perrone V, Salvati D, et al. On the relationship between human papilloma virus vaccine and autoimmune diseases. Autoimmun Rev. 2014;13(7):736–41.CrossRefPubMedGoogle Scholar
  32. 32.
    Baker B, Eca Guimaraes L, Tomljenovic L, Agmon-Levin N, Shoenfeld Y. The safety of human papilloma virus-blockers and the risk of triggering autoimmune diseases. Expert Opin Drug Saf. 2015;14(9):1387–94.CrossRefPubMedGoogle Scholar
  33. 33.
    Feldman G, Zer M. Infantile acute pancreatitis after mumps vaccination simulating an acute abdomen. Pediatr Surg Int. 2000;16(7):488–9.Google Scholar
  34. 34.
    Adler JB, Mazzotta SA, Barkin JS. Pancreatitis caused by measles, mumps, and rubella vaccine. Pancreas. 1991;6(4):489–90.Google Scholar
  35. 35.
    Cebria L, Perez Roldan F, Sanchez E, Rodriguez-Laiz JM, Casado M, Robles J, et al. Acute pancreatitis caused by parotiditis vaccine. Pancreas. 1994;9(3):390–1.Google Scholar
  36. 36.
    Hansen LF, Nordling MM, Mortensen HB. [Acute pancreatitis associated with MMR vaccination]. Ugeskr Laeger. 2003;165(22):2305–6.Google Scholar
  37. 37.
    Dawson TA, Slattery C. Subcutaneous fat necrosis of the newborn and acute pancreatitis. Br J Dermatol. 1979;101(3):359.Google Scholar
  38. 38.
    Gatt DT. Pancreatitis following monovalent typhoid and cholera vaccinations. Br J Clin Pract. 1986;40(7):300–1.Google Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Mojca Bizjak
    • 1
  • Or Bruck
    • 1
  • Sonja Praprotnik
    • 2
  • Shani Dahan
    • 1
    • 4
    • 5
  • Yehuda Shoenfeld
    • 1
    • 3
  1. 1.The Zabludowicz Center for Autoimmune DiseasesChaim Sheba Medical CenterTel-HashomerIsrael
  2. 2.Department of RheumatologyUniversity Medical CentreLjubljanaSlovenia
  3. 3.Incumbent of the Laura Schwarz-Kipp Chair for Research of Autoimmune Diseases, Sackler Faculty of MedicineTel-Aviv UniversityTel Aviv-YafoIsrael
  4. 4.Department of Medicine ‘B’Sheba Medical CenterTel-HashomerIsrael
  5. 5.Sackler Faculty of MedicineTel-Aviv UniversityTel Aviv-YafoIsrael

Personalised recommendations