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Nasr S, Khalil S, Poiesz BJ, Banki K, Perl A. Pfizer-biontech COVID-19 RNA vaccination induces phosphatidylserine autoantibodies, cryoglobulinemia, and digital necrosis in a patient with pre-existing autoimmunity. CLINICAL IMMUNOLOGY COMMUNICATIONS 2021; 1:1-3. [PMID: 38620644 PMCID: PMC8486180 DOI: 10.1016/j.clicom.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 08/25/2021] [Indexed: 11/18/2022]
Abstract
We describe a 64-year-old Caucasian female with a history of Raynaud's disease, hand arthritis, photosensitivity, Sjogren's syndrome and leukocytoclastic vasculitis who presented with progressively worsening fingertip necrosis that began three days after receiving a first dose of Pfizer-BioNTech COVID-19 RNA vaccine. Our workup revealed cryoglobulinemia, hypocomplementemia, elevated antinuclear antibodies (ANA) and IgM antiphospholipid autoantibodies (aPL) directed against phosphatidylserine (aPL-PS), suggesting a diagnosis of systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). The patient failed to develop anti-spike IgG antibodies up to two months following vaccination. Disease progression was halted by plasmapheresis, anticoagulation, and immune suppression. We conclude that the vaccine RNA moiety may induce SLE manifesting in APS, cryoglobulinemia, hypocomplementemia, and digital necrosis.
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Affiliation(s)
- Sandy Nasr
- Department of Medicine, College of Medicine, State University of New York, 750 East Adams Street, Syracuse, NY 13210, United States
| | - Sara Khalil
- Department of Medicine, College of Medicine, State University of New York, 750 East Adams Street, Syracuse, NY 13210, United States
| | - Bernard J Poiesz
- Department of Medicine, College of Medicine, State University of New York, 750 East Adams Street, Syracuse, NY 13210, United States
| | - Katalin Banki
- Department of Medicine, College of Medicine, State University of New York, 750 East Adams Street, Syracuse, NY 13210, United States
| | - Andras Perl
- Department of Medicine, College of Medicine, State University of New York, 750 East Adams Street, Syracuse, NY 13210, United States
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Olivieri B, Betterle C, Zanoni G. Vaccinations and Autoimmune Diseases. Vaccines (Basel) 2021; 9:vaccines9080815. [PMID: 34451940 PMCID: PMC8402446 DOI: 10.3390/vaccines9080815] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/12/2021] [Accepted: 07/15/2021] [Indexed: 12/12/2022] Open
Abstract
Vaccines represent one of the most effective measures of public health medicine, saving countless lives and preventing lifelong disabilities. Vaccines are extremely safe, however, no vaccine is completely free from risks and adverse events can occur following vaccination. An adverse event following immunization (AEFI) may be a true adverse reaction caused by the vaccine or an event that temporally occurred after immunization but is not caused by it. Among the adverse reactions to vaccines, one of the most feared is the triggering of autoimmune diseases, which are a heterogeneous group of disorders characterized by dysregulation of the immune system. Currently, no mechanisms have been demonstrated that could explain the correlation between vaccination and the development of autoimmune diseases. Furthermore, epidemiological studies do not support the hypothesis that vaccines cause systemic autoimmune diseases. The only confirmed associations, although very rare, are those between the flu vaccine and Guillain-Barré syndrome, especially with old vaccine preparations, and measles-mumps-rubella (MMR) vaccine and thrombocytopenia. Due to the SARS-CoV2 pandemic, new types of vaccines have been developed and are now available. Close vaccine safety-surveillance is currently underway for these new vaccines.
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Affiliation(s)
- Bianca Olivieri
- Department of Medicine, School of Specialization in Allergy and Clinical Immunology, University of Verona, 37134 Verona, Italy;
| | - Corrado Betterle
- Department of Medicine (DIMED), Clinical Immunology and Allergy, University of Padua, 35128 Padua, Italy;
| | - Giovanna Zanoni
- Immunology Unit, University Hospital, 37134 Verona, Italy
- Correspondence:
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Bouquet É, Urbanski G, Lavigne C, Lainé-Cessac P. Unexpected drug-induced Raynaud phenomenon: Analysis from the French national pharmacovigilance database. Therapie 2017; 72:547-554. [PMID: 28336160 DOI: 10.1016/j.therap.2017.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 12/19/2016] [Accepted: 01/12/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To estimate the association between exposure to medicinal products and Raynaud phenomenon. METHODS The study used the data of all adverse drug reactions notified to the French national pharmacovigilance database. All cases reported between 1st January 1995 and 10th December 2012 were selected. A case/non-case method was used to measure disproportionality of the association between drug exposure and Raynaud phenomenon. The cases concerned all observations involving Raynaud phenomenon. Non-cases comprised all other reports of adverse drug reactions over the same period. RESULTS/DISCUSSION Among the 307,128 adverse drug reaction reports selected from the French national pharmacovigilance database, 175 involved Raynaud phenomenon, most of them affecting women (61.1%). The mean age was 50.1 years, and 8% had a past medical history of Raynaud phenomenon. According to the summaries of product characteristics, 42.3% of these cases were exposed to drugs known to induce Raynaud phenomenon. Unexpected Raynaud phenomenons (unlisted in the summaries of product characteristics) were associated with exposure to drugs for which Raynaud phenomenons are published (interferons, ribavirin, gemcitabine) or for which Raynaud phenomenons are not published (hepatitis B vaccine, isotretinoin, leflunomide, hydroxycarbamide, rofecoxib, telmisartan, zolmitriptan). CONCLUSION The case/non-case method is usually used to generate signals. Further epidemiological studies are now necessary to confirm these findings.
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Affiliation(s)
- Émilie Bouquet
- Regional pharmacovigilance centre, Angers university hospital, 49933 Angers, France.
| | - Geoffrey Urbanski
- Department of internal and vascular medicine, Angers university hospital, 49933 Angers cedex 9, France
| | - Christian Lavigne
- Department of internal and vascular medicine, Angers university hospital, 49933 Angers cedex 9, France
| | - Pascale Lainé-Cessac
- Regional pharmacovigilance centre, Angers university hospital, 49933 Angers, France
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Bonetto C, Trotta F, Felicetti P, Alarcón GS, Santuccio C, Bachtiar NS, Brauchli Pernus Y, Chandler R, Girolomoni G, Hadden RDM, Kucuku M, Ozen S, Pahud B, Top K, Varricchio F, Wise RP, Zanoni G, Živković S, Bonhoeffer J. Vasculitis as an adverse event following immunization - Systematic literature review. Vaccine 2015; 34:6641-6651. [PMID: 26398442 DOI: 10.1016/j.vaccine.2015.09.026] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 09/10/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Several types of vasculitis have been observed and reported in temporal association with the administration of various vaccines. A systematic review of current evidence is lacking. OBJECTIVE This systematic literature review aimed to assess available evidence and current reporting practice of vasculitides as adverse events following immunization (AEFI). METHODS We reviewed the literature from 1st January 1994 to 30th June 2014. This review comprises randomized controlled trials, observational studies, case series, case reports, reviews and comments regardless of vaccine and target population. RESULTS The initial search resulted in the identification of 6656 articles. Of these, 157 articles were assessed for eligibility and 75 studies were considered for analysis, including 6 retrospective/observational studies, 2 randomized controlled trials, 7 reviews, 11 case series, 46 case reports and 3 comments. Most of the larger, higher quality studies found no causal association between vaccination and subsequent development of vasculitis, including several studies on Kawasaki disease and Henoch-Schönlein purpura (IgA vasculitis). Smaller case series reported a few cases of vasculitis following BCG and vaccines against influenza and hepatitis. Only 24% of the articles reported using a case definition of vasculitis. CONCLUSIONS Existing literature does not allow establishing a causative link between vaccination and vasculitides. Further investigations were strengthened by the use of standardized case definitions and methods for data collection, analysis and presentation to improve data comparability and interpretation of vasculitis cases following immunization.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Giampiero Girolomoni
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | | | - Merita Kucuku
- Department of Vaccines Control, National Agency for Medicines and Medical Devices, Tirana, Albania
| | - Seza Ozen
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | | | - Karina Top
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | - Giovanna Zanoni
- Immunology Unit, Policlinico G.B. Rossi, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Saša Živković
- University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Jan Bonhoeffer
- Brighton Collaboration Foundation, Basel, Switzerland; University of Basel Children's Hospital, Basel, Switzerland
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Nishida N, Kudo M. Clinical features of vascular disorders associated with chronic hepatitis virus infection. Dig Dis 2014; 32:786-90. [PMID: 25376297 DOI: 10.1159/000368023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Hepatitis virus infections can be accompanied by extrahepatic manifestations that may be caused by the host's immune reaction to the viral infection. Vascular involvement is one of these manifestations and is occasionally associated with life-threatening conditions due to systemic organ failure. The unique profile of hepatitis-related vascular involvement is associated with infection by different types of hepatitis viruses. For example, polyarteritis nodosa is more frequently reported in patients with chronic hepatitis B than those with chronic hepatitis C. Similarly, membranous nephropathy is a notable manifestation among hepatitis B virus-positive patients. In contrast, patients infected with hepatitis C virus are at risk for cryoglobulinemia and membranoproliferative glomerulonephritis. Antiviral therapy is necessary to control these kinds of vasculitis related to hepatitis virus infections; however, immunosuppressive agents may be required to treat severe cases. New antiviral drugs for viral hepatitis could improve the prognosis of vascular and renal involvement.
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Affiliation(s)
- Naoshi Nishida
- Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-Sayama, Japan
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Stübgen JP. Neuromuscular disorders associated with Hepatitis B vaccination. J Neurol Sci 2010; 292:1-4. [PMID: 20207367 DOI: 10.1016/j.jns.2010.02.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 02/10/2010] [Accepted: 02/16/2010] [Indexed: 10/19/2022]
Abstract
The hepatitis B virus (HBV) is an important infectious cause of acute and chronic liver disease throughout the world. Recombinant hepatitis B vaccines have been developed to combat morbidity and mortality associated with HBV infection. These vaccines have been associated with autoimmune diseases mostly among adult vaccine recipients. Epidemiological surveys have not established unequivocal causality between the hepatitis B vaccine and the development of various autoimmune neuromuscular disorders. However, case histories and series hint at a temporal association between hepatitis B vaccines and the development of various neuropathy syndromes, polyarteritis nodosa complicated by vasculitic neuropathy, myasthenia gravis and dermatomyositis. Conceivably, the hepatitis B vaccines have a potential to occasionally trigger the onset of immune diseases in individuals with an underlying genetic or immunological susceptibility.
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Affiliation(s)
- Joerg-Patrick Stübgen
- Department of Neurology and Neuroscience, Weill Cornell Medical College/New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065-4885, USA.
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Jacobi D, Maillot F, Hommet C, Arsène S, Cottier JP, Lamisse F, Guillevin L. P-ANCA cranial pachymeningitis: a case report. Clin Rheumatol 2004; 24:174-7. [PMID: 15578248 DOI: 10.1007/s10067-004-1022-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2004] [Accepted: 08/23/2004] [Indexed: 10/26/2022]
Abstract
Pachymeningitis is an inflammatory process that thickens the dura mater. This disease has various etiologies including infectious, neoplastic, or autoimmune diseases. We present the case of a patient who developed cranial pachymeningitis with a clinical and biological picture suggestive of a neurological form of vasculitis. A 51-year-old woman developed rhinitis, otitis media, headaches, and deterioration of her condition after a course of recombinant hepatitis B vaccine. After a booster dose of the vaccine, she developed unilateral visual loss and impairment of multiple cranial nerves. Blood analysis showed inflammation and presence of antimyeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA). Cranial magnetic resonance imaging (MRI) showed pachymeningitis. A complete remission was obtained with immunosuppressive therapy. The initial clinical presentation and subsequent remission under immunosuppressive therapy were suggestive of a vasculitis with nervous system involvement. Though vasculitis was not proven histologically in this patient, we believe that MPO-ANCA-related autoimmunity provoked the patient's disease as already reported in similar cases. As pachymeningitis is a fibrosing process, early recognition and treatment of an autoimmune etiology, even in the absence of previous pulmonary or renal involvement, is required to prevent definitive neurological impairment.
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Affiliation(s)
- D Jacobi
- Service de Medecine Interne A, CHU Bretonneau, Centre Hospitalier Universitaire, 2 bis, boulevard Tonnelle, Tours, 37000, France
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Chave T, Neal C, Camp R. Henoch-Schönlein purpura following hepatitis B vaccination. J DERMATOL TREAT 2003; 14:179-81. [PMID: 14522629 DOI: 10.1080/09546630310004199] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The use of recombinant hepatitis B vaccines has led to the effective prevention of hepatitis B infection and its chronic sequelae in immunocompetent individuals. Whilst rare, a variety of serious adverse effects have been reported following vaccination including cutaneous vasculitis in eight previous cases. We describe a case of Henoch-Schönlein purpura developing after hepatitis B vaccination.
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Affiliation(s)
- T Chave
- Department of Dermatology, Leicester Royal Infirmary, Leicester LE1 5WW, UK.
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Miron D, Fink D, Hashkes PJ. Kawasaki disease in an infant following immunisation with hepatitis B vaccine. Clin Rheumatol 2003; 22:461-3. [PMID: 14677029 DOI: 10.1007/s10067-003-0785-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2003] [Accepted: 06/23/2003] [Indexed: 10/26/2022]
Abstract
The known association between hepatitis B and vasculitis has been reported in rare cases in adults after hepatitis B vaccination. We here describe a 35-day-old infant who developed Kawasaki disease 1 day after receiving his second dose of hepatitis B vaccine. Although extremely rare, this possible side effect should be noted and further investigated.
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Affiliation(s)
- Dan Miron
- HaEmek Medical Center, Afula, Technion Medical School, Haifa, Israel
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11
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Abstract
INTRODUCTION Vaccines may be responsible for adverse effects, mainly local fugitive and benign reactions. However, few cases of systemic vasculitis have been described. We report three new cases, suggesting the responsibility of vaccination in starting or reactivating systemic vasculitis. EXEGESIS We report two cases in a 64- and a 68-year-old woman with polymyalgia rheumatica and temporal arteritis after influenza and tetanus vaccination respectively, and one case in a 30-year-old man with periarteritis nodosa after hepatitis B vaccination. CONCLUSION Knowledge of such complications deserve to be expanded in order to: 1) avoid re-immunisations which are likely to result in more serious consequences; 2) avoid aggravation or reactivation of a vasculitis; and 3) control serology before hepatitis B vaccination in all persons at risk of HBV infection.
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Affiliation(s)
- D Saadoun
- Service de médecine interne, hôpital de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Paris, France
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Abstract
Immunisations have been one of the most cost-effective public health interventions in human history. Despite remarkable progress, several challenges face immunisation programs worldwide. Paradoxically, despite vaccines' clear effectiveness in reducing risks of diseases that were previously widely prevalent and caused substantial morbidity and mortality, current vaccination policies have become increasingly controversial due to concerns about vaccine safety. Vaccines, like other pharmaceutical products, are not entirely risk-free. While most known adverse effects are minor and self-limited, some vaccines have been associated with very rare but serious adverse effects. Because such rare effects are often not evident until vaccines come into widespread use, ongoing surveillance programs to monitor vaccine safety are needed. Such monitoring will be essential if the public is to accept the increasing number of new vaccines made possible by biotechnology. The interpretation of data from vaccine safety research is complex and is associated with some uncertainty. Effectively communicating this uncertainty and continuing to improve understanding of rare risks and risk factors are essential for "mature" immunisation programs to maintain public confidence in immunisations.
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Affiliation(s)
- R T Chen
- Vaccine Safety and Development Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Neau D, Bonnet F, Michaud M, Perel Y, Longy-Boursier M, Ragnaud JM, Guillard JM. Immune thrombocytopenic purpura after recombinant hepatitis B vaccine: retrospective study of seven cases. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1998; 30:115-8. [PMID: 9730294 DOI: 10.1080/003655498750003465] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Recombinant hepatitis B vaccine is usually well tolerated. Clinical and laboratory test manifestations with immunologic mechanisms have nonetheless been described following use of this vaccine. We retrospectively report 7 cases of thrombocytopenia occurring within 3 months (7 weeks on the average) of 1 or following injections of recombinant hepatitis B vaccine. Four boys and 3 girls, average age 12 y, were involved. Three had a history of immune thrombocytopenic purpura. Four had haemorrhagic manifestations. The haemogram showed thrombocytopenia (24 x 10(9)/l on the average) without alterations of the other lines. Infectious and immune aetiologies were excluded in all cases. The course varied after treatment by corticosteroids, high-dose intravenous immunoglobulin, or both. After describing the different manifestations subsequent to recombinant hepatitis B vaccination, we discuss post-vaccinal thrombocytopenias (vaccines in question, mechanisms) and the reality of this entity.
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Affiliation(s)
- D Neau
- Département de Maladies Infectieuses et Médecine Interne, Hôpital Pellegrin, Bordeaux, France
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Grasland A, Le Maître F, Pouchot J, Hazera P, Bazin C, Vinceneux P. [Adult-onset Still's disease after hepatitis A and B vaccination?]. Rev Med Interne 1998; 19:134-6. [PMID: 9775130 DOI: 10.1016/s0248-8663(97)83425-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Hepatitis A and B vaccination are generally very well tolerated. However, exceptional cases of arthritis and systemic diseases have been reported after hepatitis B vaccination. CASE REPORT The authors report a case of adult Still's disease apparently triggered by hepatitis A and B vaccination. The patient was a 38-year-old woman who presented with fever, hepatitis, pneumonitis and neurologic symptoms, compatible with the diagnosis of adult Still's disease. DISCUSSION The authors discuss the rarity of systemic diseases triggered by such vaccination, the link between hepatitis B virus and some vasculitis, and the possibility for viral bacterial infections to trigger adult Still's disease.
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Affiliation(s)
- A Grasland
- Service de médecine interne V, hôpital Louis-Mourier, Colombes
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Abstract
Liver disease is now a well recognized association with lichen planus. Recent reports suggest that the hepatitis viruses may play a central role in this association. The present report describes a case of a lichenoid reaction to hepatitis B vaccination, which has only been rarely documented previously. A 16-year-old male developed a widespread pruritic erythematous eruption 5 weeks after receiving his second dose of hepatitis B vaccine. The eruption evolved to produce strikingly blue macules before spontaneously disappearing. A skin biopsy showed an intense lichenoid reaction. The hepatitis B surface antigen component of the vaccine is probably responsible for this reaction as well as for other rare immunologically mediated reactions to hepatitis B vaccination. These reactions may provide insight into the pathogenesis of the cutaneous features of natural hepatitis B infection.
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Affiliation(s)
- C A Saywell
- Dermatology Centre, Lidcombe Hospital, Sydney, Australia
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