Aluminum granuloma after administration of the quadrivalent human papillomavirus vaccine. Report of a case.
ABSTRACT We report the case of a young woman who developed a subcutaneous granulomatous response after administration of the quadrivalent human papillomavirus vaccine. The inciting agent was most likely an aluminum adjuvant, which previously has been reported to be associated with a granulomatous response after administration of other vaccines. Histologically, the lesion consisted of a necrotic/necrobiotic center surrounded by palisading epithelioid histiocytes closely resembling deep granuloma annulare or rheumatoid nodule. The histiocytes contained abundant intracytoplasmic violaceous/gray granular material. An ammonium aurintricarboxylate (Aluminon) stain demonstrated the presence of aluminum in the granular material. Aluminum granulomas should be included in the differential diagnosis of deep granulomatous reaction in young women, due to the high frequency of vaccination in this population.
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ABSTRACT: Counseling messages for tobacco cessation, condom use, circumcision, and selective choice in the number of sexual partners can help reduce the risk of cervical cancer. Other sexual behavioral and reproductive risk factors for cervical cancer are a younger age at first intercourse and at first full-term pregnancy as well as increasing duration of combined hormonal oral contraceptive use. Micronutrients and supplements can reduce the risk of human papillomavirus infection, persistence, progression, and regression. Some human papillomavirus infections can be prevented by vaccination. Cervical cancer is best prevented by screening.Clinical obstetrics and gynecology 03/2014; DOI:10.1097/GRF.0000000000000027 · 1.53 Impact Factor
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ABSTRACT: The frequency of long-lasting, intensely itching subcutaneous nodules at the injection site for aluminium (Al)-adsorbed vaccines (vaccination granulomas) was investigated in a prospective cohort study comprising 4,758 children who received either a diphtheria-tetanus-pertussis-polio-Haemophilus influenzae type b vaccine (Infanrix®, Pentavac®) alone or concomitant with a pneumococcal conjugate (Prevenar). Both vaccines were adsorbed to an Al adjuvant. Altogether 38 children (0.83 %) with itching granulomas were identified, epicutaneously tested for Al sensitisation and followed yearly. Contact allergy to Al was verified in 85 %. The median duration of symptoms was 22 months in those hitherto recovered. The frequency of granulomas induced by Infanrix® was >0.66 % and by Prevenar >0.35 %. The risk for granulomas increased from 0.63 to 1.18 % when a second Al-adsorbed vaccine was added to the schedule. Conclusion: Long-lasting itching vaccination granulomas are poorly understood but more frequent than previously known after infant vaccination with commonly used diphtheria-tetanus-pertussis-polio-Haemophilus influenzae type b and pneumococcal conjugate vaccines. The risk increases with the number of vaccines given. Most children with itching granulomas become contact allergic to aluminium. Itching vaccination granulomas are benign but may be troublesome and should be recognised early in primary health care to avoid unnecessary investigations, anxiety and mistrust.European Journal of Pediatrics 04/2014; DOI:10.1007/s00431-014-2318-2 · 1.98 Impact Factor
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ABSTRACT: We report the case of an eighteen years old woman who developed a subcutaneous nodular lesion localized on her right upper arm. Conventional histological examination revealed a lesion characterized by a necrotic center surrounded by palisading epithelioid histiocytes embedded into the fibroadipous and skeletal muscle tissue. Transmission electron microscopy analysis confirmed the histological observations in terms of cellular composition of the granuloma. The ultrastructural microanalysis shed light on the elemental composition of the examined granulomatous formation since it clearly detected metallic deposits with an emission pick at EDX for aluminum within the hystocites’s granules. Our results support previous published data on the reactive nature of granulomatous reaction at the site of vaccine. The presence of aluminum inside the cytoplasm of macrophages proved by microanalysis gives strength to the etiopatogenic hypothesis of the granuloma formation.Journal of medical cases 07/2013; 4(7):461-465. DOI:10.4021/jmc1193w