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A 4-month-old baby presenting with dermal necrotizing granulomatous giant cell reaction at the injection site of 13-valent pneumococcal conjugate vaccine: a case report.

Alsuwaidi AR, Albawardi A, Khan NH, Souid AK - J Med Case Rep (2014)

Bottom Line: This reaction probably resulted from improper intramuscular administration because the first (at 2 months of age) and third (at 10 months of age) doses were uneventful.Dermal necrotizing granulomatous reactions are a serious complication of the 13-valent pneumococcal conjugate vaccine.Completing the vaccine series is an acceptable option.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pediatrics, United Arab Emirates University, P,O, Box 17666, Al-Ain, UAE. alsuwaidia@uaeu.ac.ae.

ABSTRACT

Introduction: Adjuvants (for example, aluminum salts) are frequently incorporated in licensed vaccines to enhance the host immune response. Such vaccines include the pneumococcal conjugate, combinations of diphtheria-tetanus/acellular pertussis, tetanus- diphtheria/acellular pertussis, hepatitis B, some Haemophilus influenzae type b, hepatitis A, and human papillomavirus. These preparations have been associated with complicated local adverse events, especially if administered subcutaneously or intradermally in comparison to deep intramuscular injection. We describe a severe inflammatory reaction at the site of an injection of 13-valent pneumococcal conjugate vaccine.

Case presentation: A 4-month-old Arab baby boy developed dermal necrotizing granulomatous giant cell reaction at the injection site (right anterior thigh) of the second dose of 13-valent pneumococcal conjugate vaccine. Ziehl-Neelsen and periodic-acid Schiff were negative. This reaction probably resulted from improper intramuscular administration because the first (at 2 months of age) and third (at 10 months of age) doses were uneventful.

Conclusions: Dermal necrotizing granulomatous reactions are a serious complication of the 13-valent pneumococcal conjugate vaccine. Health care providers need to administer this preparation deeply into a muscle mass. Completing the vaccine series is an acceptable option. Physicians are encouraged to report their experience with completing vaccine series following adverse events.

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Related in: MedlinePlus

Radiological images of the lesion 3 weeks after administering the 13-valent pneumococcal conjugate vaccine.PanelA: Right knee X-ray showing anterior fluid collection. PanelB: Ultrasound of the right knee showing swelling (measuring 2.9cm transversely and 1.5cm anteroposteriorly) of the anterior aspect of the knee due to fluid collection.
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Figure 1: Radiological images of the lesion 3 weeks after administering the 13-valent pneumococcal conjugate vaccine.PanelA: Right knee X-ray showing anterior fluid collection. PanelB: Ultrasound of the right knee showing swelling (measuring 2.9cm transversely and 1.5cm anteroposteriorly) of the anterior aspect of the knee due to fluid collection.

Mentions: A 4-month-old previously healthy Arab baby boy presented with progressive swelling, redness, and firmness at the injection site (right anterior thigh) of his second PCV13 dose. The findings were noticeable within 24 hours of the vaccination and progressed rapidly into the prepatellar area.At 3 weeks, the clinical findings in the anterior aspect of his knee were very prominent (FigureĀ 1), prompting draining of the lesion. The aspirate (10mL) yielded a sterile pus (Gram stain and bacterial culture were negative). Nevertheless, he received an empiric course of flucloxacillin.


A 4-month-old baby presenting with dermal necrotizing granulomatous giant cell reaction at the injection site of 13-valent pneumococcal conjugate vaccine: a case report.

Alsuwaidi AR, Albawardi A, Khan NH, Souid AK - J Med Case Rep (2014)

Radiological images of the lesion 3 weeks after administering the 13-valent pneumococcal conjugate vaccine.PanelA: Right knee X-ray showing anterior fluid collection. PanelB: Ultrasound of the right knee showing swelling (measuring 2.9cm transversely and 1.5cm anteroposteriorly) of the anterior aspect of the knee due to fluid collection.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4150417&req=5

Figure 1: Radiological images of the lesion 3 weeks after administering the 13-valent pneumococcal conjugate vaccine.PanelA: Right knee X-ray showing anterior fluid collection. PanelB: Ultrasound of the right knee showing swelling (measuring 2.9cm transversely and 1.5cm anteroposteriorly) of the anterior aspect of the knee due to fluid collection.
Mentions: A 4-month-old previously healthy Arab baby boy presented with progressive swelling, redness, and firmness at the injection site (right anterior thigh) of his second PCV13 dose. The findings were noticeable within 24 hours of the vaccination and progressed rapidly into the prepatellar area.At 3 weeks, the clinical findings in the anterior aspect of his knee were very prominent (FigureĀ 1), prompting draining of the lesion. The aspirate (10mL) yielded a sterile pus (Gram stain and bacterial culture were negative). Nevertheless, he received an empiric course of flucloxacillin.

Bottom Line: This reaction probably resulted from improper intramuscular administration because the first (at 2 months of age) and third (at 10 months of age) doses were uneventful.Dermal necrotizing granulomatous reactions are a serious complication of the 13-valent pneumococcal conjugate vaccine.Completing the vaccine series is an acceptable option.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pediatrics, United Arab Emirates University, P,O, Box 17666, Al-Ain, UAE. alsuwaidia@uaeu.ac.ae.

ABSTRACT

Introduction: Adjuvants (for example, aluminum salts) are frequently incorporated in licensed vaccines to enhance the host immune response. Such vaccines include the pneumococcal conjugate, combinations of diphtheria-tetanus/acellular pertussis, tetanus- diphtheria/acellular pertussis, hepatitis B, some Haemophilus influenzae type b, hepatitis A, and human papillomavirus. These preparations have been associated with complicated local adverse events, especially if administered subcutaneously or intradermally in comparison to deep intramuscular injection. We describe a severe inflammatory reaction at the site of an injection of 13-valent pneumococcal conjugate vaccine.

Case presentation: A 4-month-old Arab baby boy developed dermal necrotizing granulomatous giant cell reaction at the injection site (right anterior thigh) of the second dose of 13-valent pneumococcal conjugate vaccine. Ziehl-Neelsen and periodic-acid Schiff were negative. This reaction probably resulted from improper intramuscular administration because the first (at 2 months of age) and third (at 10 months of age) doses were uneventful.

Conclusions: Dermal necrotizing granulomatous reactions are a serious complication of the 13-valent pneumococcal conjugate vaccine. Health care providers need to administer this preparation deeply into a muscle mass. Completing the vaccine series is an acceptable option. Physicians are encouraged to report their experience with completing vaccine series following adverse events.

Show MeSH
Related in: MedlinePlus