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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

Histopathology. PanelA: Low power view (4×): Tissue section of skin demonstrates hyperkeratosis (*), epidermal acanthosis (thickening, triangle) and an inflammatory dermal process (star). PanelB: Intermediate power view (20×): Dermal granuloma formation accompanied by multinucleated giant cells (arrows). PanelsC-D: High power view (40×): Granulomatous giant cell inflammatory reaction, collection of epithelioid histiocytes admixed with lymphocytes rimmed by multinucleated giant cells.
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Figure 2: Histopathology. PanelA: Low power view (4×): Tissue section of skin demonstrates hyperkeratosis (*), epidermal acanthosis (thickening, triangle) and an inflammatory dermal process (star). PanelB: Intermediate power view (20×): Dermal granuloma formation accompanied by multinucleated giant cells (arrows). PanelsC-D: High power view (40×): Granulomatous giant cell inflammatory reaction, collection of epithelioid histiocytes admixed with lymphocytes rimmed by multinucleated giant cells.

Mentions: At 8 weeks, he had a second drainage and open skin and soft tissue biopsies. The findings revealed erythema induratum, a granulomatous inflammation with fibrinoid and caseous necrosis (Figure 2). Ziehl–Neelsen and periodic-acid Schiff stains (special stains for mycobacteria and fungi) were negative. Gram stain showed 3+ pus cells with no organisms. Wound bacterial culture grew 1+ Klebsiella pneumoniae, considered a secondary infection. The patient received oral cefixime.


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)

Histopathology. PanelA: Low power view (4×): Tissue section of skin demonstrates hyperkeratosis (*), epidermal acanthosis (thickening, triangle) and an inflammatory dermal process (star). PanelB: Intermediate power view (20×): Dermal granuloma formation accompanied by multinucleated giant cells (arrows). PanelsC-D: High power view (40×): Granulomatous giant cell inflammatory reaction, collection of epithelioid histiocytes admixed with lymphocytes rimmed by multinucleated giant cells.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Histopathology. PanelA: Low power view (4×): Tissue section of skin demonstrates hyperkeratosis (*), epidermal acanthosis (thickening, triangle) and an inflammatory dermal process (star). PanelB: Intermediate power view (20×): Dermal granuloma formation accompanied by multinucleated giant cells (arrows). PanelsC-D: High power view (40×): Granulomatous giant cell inflammatory reaction, collection of epithelioid histiocytes admixed with lymphocytes rimmed by multinucleated giant cells.
Mentions: At 8 weeks, he had a second drainage and open skin and soft tissue biopsies. The findings revealed erythema induratum, a granulomatous inflammation with fibrinoid and caseous necrosis (Figure 2). Ziehl–Neelsen and periodic-acid Schiff stains (special stains for mycobacteria and fungi) were negative. Gram stain showed 3+ pus cells with no organisms. Wound bacterial culture grew 1+ Klebsiella pneumoniae, considered a secondary infection. The patient received oral cefixime.

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