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

Abstract

BackgroundCutaneous dermatoses and malignancies have occurred at the sites of vaccines.PurposeTo 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.MethodsPubMed 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.ResultsSeveral 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.ConclusionsDermatoses 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.

Blue Nevus Developing at a Combined Tetanus, Diphtheria, and Pertussis (Tdap) Vaccination Site: Case Report and Summary of Vaccine-Associated Cutaneous Lesions

“…Numerous cutaneous reactions have been observed at the sites of both live and attenuated vaccinations. These reactions include not only inflammatory reactions such as lichenoid and granulomatous dermatosis, but also neoplasms such as basal cell carcinoma, dermatofibrosarcoma protuberans, and squamous cell carcinoma (Table 1, Table 2) [1]. Skin-related reactions specific to diphtheria, tetanus, and pertussis vaccination include deep reactive nodular infiltrates of mixed inflammation, Mycobacterium tuberculosis abscess, and necrotizing granuloma (Table 3) [6-7].…”

“…Adverse cutaneous events can occur in vaccine injection sites [1]. These include inflammatory reactions and neoplasms.…”

Late onset of injection site reactions after vaccination with the 13-valent pneumococcal conjugate vaccine in adult study populations

“… 21 , 22 In this scenario, a “form fruste inflammatory reaction” could form at the vaccination site, a location that may be susceptible to localized immunologic changes due to skin injury. 23 …”

Basal cell carcinoma associated with non-neoplastic cutaneous conditions: a comprehensive review

“…Indeed, scar tissue may be more likely to promote the development of cancer since the site has diminished blood supply, atrophy of adnexal structures and epidermis, and increased sensitivity to the effects of ultraviolet radiation [83,84]. Basal cell carcinoma has occurred in scars from various primary etiologies: burns [83][84][85][86][87][88][89][90][91][92], dog bites [90], epidermolysis bullosa [93], infections [94-Dermatology Online Journal || Review 97], shotgun [98,99], surgery [100][101][102][103][104][105], trauma [83], and vaccinations [84,106,107].…”

“…Vaccination sites may subsequently develop scars. Melanoma and non-melanona skin cancers have occurred in vaccination scars; the most common vaccination site-associated cutaneous neoplasms are BCC and squamous cell carcinoma [84,106,107]. Basal cell carcinoma has been at the sites of inoculation of the following vaccines: Bacillus Calmette-Guerin [107], influenza [106], and smallpox [107].…”