Cytophagic Histiocytic Panniculitis after H1N1 Vaccination: A Case Report and Review of the Cutaneous Side Effects of Influenza Vaccines

Abstract

Cytophagic histiocytic panniculitis (CHP) is a rare disease mostly caused by viral infections and/or lymphoproliferative diseases. We describe a case of CHP associated with H1N1 vaccine during the winter 2009–2010 vaccination campaign and discuss the cutaneous side effects of influenza vaccines. A 6-year-old child presented with inflammatory subcutaneous nodules, which had appeared 1 month after the first injection of H1N1 vaccine and 1 week after the second injection. There was no history of recent infection. The skin lesions spontaneously disappeared without scarring. In CHP the abnormal cytokine secretion from neoplastic or reactive T cells promotes monocyte-macrophage activation and haemophagocytosis. Vaccination is not a common cause of CHP, but it seems possible that, as in infectious diseases, reactive T cells to the vaccine antigen could trigger CHP.

Co-Existence of nodular purpura and vaccine induced panniculitis in a 4-month-old baby-a diagnostic dilemma

“…After an extensive literature search, we were able to find few reports with cancer immunotherapy[ 5 ] and the H1N1 vaccine. [ 6 ] Evidence was strongest for the occurrence of erythema nodosum with a number of vaccines such as hepatitis B, rabies, pneumococcal, and typhoid. [ 7 8 ] Components like vaccine antigens or vehicles have been alleged to mounting abnormal sustained immune responses leading to chronic inflammation.…”

Paniculitis histiocítica citofágica con remisión espontánea

“…Su origen se asocia a una reacción secundaria a la proliferación benigna de linfocitos T o desorden de las células T, que puede ser causada por infecciones virales (principalmente Epstein-Barr), bacterianas o parasitarias; malignidad y, ocasionalmente, enfermedades reumatológicas 1,2 . En 2011 se publicó un caso asociado a la vacunación contra el H1N1 3 . Su principal diagnóstico diferencial son los linfomas cutáneos de células T con compromiso subcutáneo, sobre todo los que expresan un fenotipo citotóxico y, alguna vez, el fenotipo NK/T 4 .…”

Cytophagic Histiocytic Panniculitis (CHP) in a Patient with SLE Found after Autopsy: When a Rash Is “Complicated!”

“…It is a rare cause of aseptic panniculitis [2–4] that is seen in association with viral infections (HSV, EBV) [5], hematopoietic disorders (malignant lymphoma), hemophagocytic lymphohistiocytosis (HLH), acute leukemias (acute lymphoid leukemia, acute myeloid leukemia), Hodgkin's and non-Hodgkin's lymphoma, rhabdomyosarcoma, neuroblastoma, and Langerhans cell histiocytosis [6, 7]. Reports of CHP after H1N1 vaccination are available in the literature [8]. Its association with autoimmune diseases like systemic lupus erythematosus (SLE) is also reported and has a high mortality rate [9–12].…”