Unusual cause of thigh abscess in infant following hepatitis B vaccine administration

Abstract

A 30 days old healthy male infant with left thigh swelling was presented to our clinic by his family. Parents gave no history of diseases or trauma and was administered hepatitis B vaccine from left thigh one week before. Physical exam revealed approximately 3×2 cm, erythematous, indurated, tender to palpation, fluctuating soft tissue swelling over the anterolateral left thigh. During needle puncture, 15 cc purulent liquid was aspirated. As the liquid was purulent, irrigation and debridement were performed. Following six weeks of antibiotic treatment, the patient was completely recovered.

Full text

Journal of Experimental and Clinical Medicine
Case Report doi: 10.5835/jecm.omu.30.02.019
Unusual cause of thigh abscess in infant following hepatitis B vaccine administration
Sabit Numan Kuyubaşıa*, Eyup Cagatay Zengina, Alper Çıraklıa, Sevgi Çıraklıb, Mesut Kılıça
aDepartment of Orthopedics and Traumatology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
bDepartment of Pediatrics, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
ARTICLE INFO ABSTRACT
Article History
Received 05 / 02 / 2013
Accepted 11 / 02 / 2013
A 30 days old healthy male infant with left thigh swelling was presented to our clinic by
his family. Parents gave no history of diseases or trauma and was administered hepatitis
B vaccine from left thigh one week before. Physical exam revealed approximately 3x2
cm, erythematous, indurated, tender to palpation, uctuating soft tissue swelling over the
anterolateral left thigh. During needle puncture, 15 cc purulent liquid was aspirated. As
the liquid was purulent, irrigation and debridement were performed. Following six weeks
of antibiotic treatment, the patient was completely recovered.
J. Exp. Clin. Med., 2013; 30:181-182
© 2013 OMU
* Correspondence to:
Sabit Numan Kuyubaşı
Department of Orthopedics and Traumatology,
Faculty of Medicine,
Ondokuz Mayıs University, Kurupelit,
Samsun, Turkey
e-mail: s.numankuyubası@hotmail.com
Keywords:
Abscess
Adverse effects
Hepatitis B vaccines
Surgery
1. Introduction
Hepatitis B vaccine is considered as quite a safe vaccine
among current vaccines (Sahin et al., 2011). Although com-
plications are expected such as pain in administration area
or mild fever following hepatitis B (3%-9%), severe side ef-
fects are very rare (Sahin et al., 2011). For development of
side effects following vaccine administration, administration
age, quality of vaccine, administration area and technique are
very important (Namshan et al., 2011). The factors associated
to administration technique are the most important causes in
development of post vaccine complications (Namshan et al.,
2011). In this case presentation, we discussed a case present-
ed to our clinic with a swelling in thigh following hepatitis B
vaccine administration.
2. Case
A 30-days-old healthy male infant with left thigh swelling was
presented to our clinic by his family. Parents gave no history
of diseases or trauma and was administered hepatitis B vaccine
from left thigh one week before. His symptoms started follow-
ing vaccine administration and they were referred to our clinic
as swelling in thigh was grown progressively, redness developed
and infant had difculty moving his extremity. Physical exam in-
ation revealed approximately 3x2 cm, erythematous, indurated,
tender to palpation, uctuating soft tissue swelling over antero-
lateral left thigh (Fig. 1). Heat increase was detected over lesion.
Vital signs were normal. Laboratory tests showed that white
blood cells (WBC) 15.2×109/L, sedimentation rate 25 mm/h, C-
reactive protein (CRP) 71 mg/L. Direct radiography showed no
lesion except soft tissue swelling. Supercial tissue ultrasonog-
raphy demonstrated 44x31x80 mm, dense collection which was
extended to distal femur, not in connection with the knee joint,
abscess- hematoma differentiation could not be made, in the left
anterior femur.
After making thigh abscess initial diagnosis, sterile needle
puncture was performed to uctuating soft tissue in operation
room. During needle puncture, 15 cc purulent liquid was aspi-
rated (Fig. 2). As the liquid was purulent, irrigation and debride-
ment were performed (Fig. 3). The culture of aspirated uid was
resulted with Staphylococcus aureus. Based on Pediatric Infec-
tious Disease consultant recommendations, cefotaxime, metro-
nidazole and teicoplanin treatment were given for six weeks.
Complete recovery was achieved after three month- follow up.

182
Fig. 3. Incision and drainage of the abscess.
3. Discussion
Hepatitis B vaccine is a highly safe and efcient vaccine com-
monly used in all around the world. While pain and swelling
in injection area and subfebrile fever are most commonly
seen among side effects, these ndings often limit themselves
(Sahin et al., 2011). Systemic side effects are less common.
Side effects caused by vaccine injection are more commonly
seen when it is administered especially in the areas with low
sociocultural level and without adequate logistic support by
health personnel with insufcient training. Vaccine injection
to wrong side for age, inaccurate doses, use of inaccurate di-
lution liquids and administration of non-sterile injectors may
lead to soft tissue infection (Namshan et al., 2011). Technical
factors are the most important causes in post vaccine compli-
cation development (Namshan et al., 2011). For achieving op-
timal effect of vaccination and prevention from unnecessary
local and systemic effects, vaccine should be administered
via suggested route. Abscess in vaccine area may be related
to use of bacterial contaminated needle and injectors or it can
also be seen as sterile abscess due to subcutaneous admin-
istration of especially adjuvant containing vaccines instead
of intramuscular or inappropriate preparation of vaccine and
poor storage conditions (Namshan et al., 2011). Akdeniz et
al. (2006) reported that post hepatitis B vaccine side effects
were least seen in the subcutaneous injection group, most in
intramuscular injection group. We believe that the abscess
in this case was caused by use of inappropriate vaccination
technique without paying attention to sterility. In conclusion,
we think that use of appropriate techniques during vaccine
injection is the most important step to prevent development
of vaccine related side effects.
Fig. 1. Soft tissue swelling over left thigh.
Fig. 2. 15 cc purulent liquid was aspirated with needle puncture.
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Journal of Experimental and Clinical Medicine 30 (2013) 181-182