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Single photon emission computed tomography findings after human papillomavirus (HPV) vaccination in Japan

      Almost of previous investigations for adverse clinical symptoms after human papilloma virus (HPV) vaccination described that the symptoms appeared to be complex regional pain syndrome or psychogenic disorders. However we have a chance for investigating over 100 patients with widespread pain, general fatigue, autonomic dysfunction, memory impairment, hyper photosensitivity, impairment of locomotor system, et al. after HPV vaccination. Based on these clinical symptoms, we postulated HPV vaccination associated with neuro-immunopathic syndrome (HANS). The aim of this study was to clarify central nervous system impairment using single photon emission computed tomography (SPECT). We recruited patients diagnosed as HANS (HPV vaccine Associated with Neuro immunopathic Syndrome) which was proposed by us in 2014. Consecutive patients with HANS were admitted to our hospital between March and December 2014. Patients with previous history of psychological or physiological symptoms before HPV vaccination were excluded. In SPECT study, we selected N-isopropyl-p-123I-iodoamphetamine as an isotope, and used normal data base from 19 healthy volunteers (15 females, 15.5 ± 5.2 aged), and evaluated the statistically hypo-perfusion area in three-dimensional stereotactic surface projection(3D-SSP)in patients. Furthermore, we performed Stereotactic Extraction Estimation (SEE) in which Z-score was over 2.0 and extent ratio was over 10%. 30 patients (all females, 14–20 aged, median 17.0 aged) were enrolled. Relative hypo-perfusion area in 3D-SSP with SEE analysis was most prominent in anterior cingulate gyrus in the HANS patients. This study strongly suggested that various clinical symptoms with the HANS patients were caused by central nervous system impairment after HPV vaccination.
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