Discoid lupus erythematosus occurring in a smallpox vaccination scar

Injection Site Lichenoid Dermatitis Following Pneumococcal Vaccination: Report and Review of Cutaneous Conditions Occurring at Vaccination Sites

Background

Cutaneous dermatoses and malignancies have occurred at the sites of vaccines.

Purpose

To describe a man who developed a lichenoid dermatitis at the pneumococcal vaccine injection site and to review cutaneous dermatoses and malignancies occurring at vaccination sites.

Methods

PubMed was used to search the following terms, separately and in combination: adverse, condition, cutaneous, dermatosis, dermatitis, injection, PCV13, pneumococcal, pneumonia, prevnar, reaction, skin, site, vaccination, and vaccine. All papers were reviewed, and relevant manuscripts, along with their reference citations, were evaluated.

Results

Several vaccines—including bacillus Calmette-Guerin, hepatitis B, influenza, leishmaniasis, meningitis, pneumococcal, smallpox, tetanus (alone and in combination with diphtheria, pertussis, polio, Haemophilus influenza type B or plague and yellow fever), and varicella-zoster—have been associated with post-vaccination site reactions. A 70-year-old male developed a lichenoid dermatitis that occurred at the pneumococcal vaccine injection site within 2 weeks after PCV13 vaccination; the erythematous nodule resolved spontaneously within 9 weeks following immunization.

Conclusions

Dermatoses at the injection sites of vaccines can be granulomatous, immunity-related conditions, infections, lichenoid, neutrophilic, or pseudolymphomatous. Basal cell carcinoma and squamous cell carcinoma are the most common vaccination site-associated malignancies; however, melanoma and sarcomas (dermatofibrosarcoma protuberans, fibrosarcoma, and malignant fibrous histiocytoma) are also smallpox vaccine-related site neoplasms. A cutaneous immunocompromised district that is created by vaccine-induced local immunologic changes is hypothesized to be the pathogenesis of vaccination site reactions.

Dermatological lesions near the smallpox vaccination site after scab detachment

Lesions arising after scab detachment at the smallpox vaccination site have been described in the medical literature. We investigated reports of postscab lesions among US civilian volunteers vaccinated against smallpox from January through August 2003. We conducted enhanced surveillance, using a standard questionnaire, for reports of skin lesions appearing at or near the smallpox vaccination site after scab detachment. We identified 21 reports; 19 of the case patients responded to our questionnaire. The lesions (scab and/or fluid) of 7 case patients were tested for vaccinia virus by use of polymerase chain reaction and/or immunohistochemistry; all were found to be negative. We contacted 18 case patients 11 months after the initial lesion appearance; 10 (56%) of the 18 reported having another lesion appear after the initial postscab lesion had resolved. Lesions were heterogeneous in morphology, clinical appearance, and histology. The evidence from our case series and follow-up suggests that these lesions are self-limited, without significant clinical sequelae.

Papular spongiotic dermatitis of smallpox vaccination: report of 2 cases with review of the literature

We report 2 cases of nonspecific postvaccinial dermatitis following smallpox vaccination. The patients presented with diffuse, pruritic, erythematous macules and papules 11 days (case 1) and 7 days (case 2) following routine smallpox vaccination. Biopsies of the lesions demonstrated spongiotic dermatitis without evidence of viral cytopathic changes. One case showed a pityriasis rosea-like histologic pattern. The exanthema resolved without sequelae with symptomatic treatment (case 1). Review of historical literature demonstrated the association of a variety of nonspecific cutaneous complications with vaccinia inoculation, including erythema multiforme, urticaria, and pityriasis rosea. The association of these various dermatitides with smallpox immunization is not well known and is likely underreported.

Dermatofibrosarcoma protuberans occurring in a smallpox vaccination scar

Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive, rarely metastatic, spindle cell tumor. Trauma has been associated with its development. Since the 1940s, malignant tumors have been described to occur in sites of smallpox vaccination scars. Five cases in the literature document DFSP arising in sites of prior immunizations. We report a case of DFSP occurring in a smallpox vaccination scar and review the available literature.

Graves' disease presenting as localized myxoedematous infiltration in a smallpox vaccination scar

We describe a 54-year-old woman with diffuse myxoedematous infiltration at the site of a smallpox vaccination scar as the presenting symptom of Graves' disease. Associated features included acute ocular symptoms (vascular congestion of the sclera, epiphora and blurred vision) and transient erythema on both shins. However, there were no signs of pretibial myxoedema. A number of neoplastic, inflammatory and systemic diseases may localize to scar tissue in skin, including at smallpox vaccination sites, but this case demonstrates the unusual occurrence of myxoedematous infiltration at such a site and illustrates a most atypical cutaneous presentation of Graves'disease.