Pneumococcal vaccine
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First report of cutaneous Rosai-Dorfman disease in an elderly patient: case report A 68-year-old woman developed cutaneous RosaiDorfman disease after receiving pneumococcal vaccine. The woman was referred with a 2-year history of an expanding lesion on her right arm. The lesion had originally appeared several days after she received 23-valent pneumococcal polysaccharide vaccine [drug details not stated]. The lesion had initially been a tender erythematous papule at the vaccine site, which had increased in size and spread to additional sites. She had been unsuccessfully treated with rifampicin, azithromycin and moxifloxacin. At the current presentation she had a large erythematous plaque on her right arm, with numerous hyperkeratotic papulonodules. Also, on her left arm, face, ears, forearms and thighs she had erythematous macules forming larger patches with scaling. Biopsy showed a mixed dermal infiltrate including foamy histiocytes, plasma cells, lymphocytes and neutrophils. There were also large, pale histiocytes with feathery borders, which were S-100 positive. The woman was treated over a 3-year period with corticosteroids, dapsone, isotretinoin and cryotherapy, and improved. Author comment: "[O]ur patient developed [cutaneous Rosai-Dorfman disease] after pneumococcal vaccination. As the eruption was temporally related and initially localized to the site of injection, we believe that an exaggerated immunological response to the vaccination is a likely cause for this case of [cutaneous Rosai-Dorfman disease].’ Bassis AV, et al. Cutaneous Rosai-Dorfman disease following pneumococcal vaccination. Journal of the American Academy of Dermatology 65: 890-892, No. 4, Oct 2011. Available from: URL: http://dx.doi.org/10.1016/j.jaad.2011.03.019 803062508 USA
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Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of cutaneous Rosai-Dorfman disease associated with 23-valent pneumococcal polysaccharide vaccine. The WHO ADR database contained no reports of Rosai-Dorfman syndrome associated with pneumococcal vaccine.
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Reactions 12 Nov 2011 No. 1377
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