Delayed-type hypersensitivity to vaccine aluminum adjuvant causing subcutaneous leg mass and urticaria in a child

Pediatric Dermatology
Samantha C GordonElena B Hawryluk

Abstract

A 3-year-old girl presented with a 7-month history of a waxing and waning left thigh mass associated with pruritus and erythema at the site of two previous DTaP-HepB-IPV vaccinations. Patch testing was positive to aluminum chloride, supporting a diagnosis of vaccine granuloma secondary to aluminum allergy; her symptoms had been well controlled with antihistamines and topical steroids. Injection site granulomas are a benign but potentially bothersome reaction to aluminum-containing immunizations that can be supportively managed, and we encourage strict adherence to the recommended vaccine schedule in this setting. Patch testing is a sensitive, noninvasive diagnostic tool for patients presenting with this clinical finding, and dermatologist awareness can prevent unnecessary medical examination and provide reassurance.

References

May 1, 1992·Contact Dermatitis·K KaaberN K Veien
Oct 1, 1984·Archives of Dermatology·H A Fawcett, N P Smith
Oct 1, 1996·Journal of Clinical Pathology·G A CuloraJ M Theaker
Apr 19, 2015·Clinics in Dermatology·Adena E Rosenblatt, Sarah L Stein

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Citations

Jan 25, 2019·Pediatric Dermatology·Fátima Tous-RomeroJavier Ortiz de Frutos
Feb 28, 2019·Expert Review of Vaccines·Rowena SilcockKirsten P Perrett
Aug 26, 2020·Expert Review of Clinical Immunology·Lucrezia SartiJean-Christoph Caubet

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