Sex: M
Vaccine: DTOX, HIBV, MMRV, TTOX
Symptoms: Anti-vimentin antibody positive, Antibody test, Blast cell count decreased, Blood immunoglobulin G decreased, Bone lesion
Clinical narrative: absent specific antibody response to all vaccines tested; This literature marketed report has been received from the authors of a published literature article, titled as stated below, referring to a male child.  The patient's concurrent conditions included cherubism, developmental delay, autism, dysmorphic face, downturned and lowset ears, down-slanted eye, tethered tongue base, generalized joint hypermoblilty, cutis laxa, asthma, allergic rhinitis, gastric outlet obstruction from pyloric stenosis, a palate fistula with velopharyngeal insufficiency since age 9, and an aortic aneurysm involving the ascending aorta and intra-abdominal descending aorta at age 10. His medical history included recurrent episodes of otitis media, mastoiditis, sinusitis, several bilateral myringotomy and tubes surgeries since age 3, several functional several functional endoscopic sinus surgeries with sinus debridement since age 4, right tympanomastoidectomy at age 5, several instances of left mastoid debridement from ages 5 to 6, episodes of nodular, vesicular, pustular, or pannicular rash, recurrent episodes granuloma annulare, recurrent episodes of onychomycosis, paronychia, and cellulitis complicated by right third toe amputation at age 9 for an inflammatory mass associated with Staphylococcus pseudintermedius.  On unknown dates, the patient was vaccinated with haemophilus b conjugate vaccine (meningococcal protein conjugate) (manufacturer unknown), measles, mumps, rubella and varicella (oka-merck) virus vaccine live (manufacturer unknown), tetanus vaccine (unspecified), diphtheria vaccine (unspecified), Streptococcus pneumoniae vaccine (unspecified) and rubeola vaccine (unspecified) (dose, route of administration, anatomical location, lot# and expiry date were not reported); all the suspect vaccines were administered for prophylaxis.  On an unknown date, in radiologic evaluation, the patient was found to have bilateral expansile lucent bone lesions within the maxilla and mandibular rami soap-bubble appearance. Incisional biopsy showed bland cellular fibroproliferative ovoid to spindle-shaped stromal cells with associated scattered multinucleated giant cells, irregular spicules of lamellar and woven bone, and small-caliber intralesional blood vessels surrounded by cuff-like deposits of eosinophilic material. Spindled lesional cells analysis was positive for vimentin, which confirmed the lesion's mesenchymal origin, and negative for S100, smooth muscle actin, and CD1a, which ruled out smooth muscle or myofibroblast proliferations, Langerhans cell histiocytosis, and nerve sheath or melanocytic tumors. Giant cells analysis was positive for CD68. The Ki-67 proliferation index was low (less than 3%). Clinical laboratory results demonstrated that total B cell count was decreased, and CD27+ memory B cells were decreased, precluding the assessment of switched versus unswitched memory T cells. The patient's immunoglobin G (IgG) was less than 61 mg/dL (decreased), and the specific antibody response was absent to all vaccines tested; tetanus IgG was less than 0.1 IU/mL, diphtheria IgG was less than 0.1 IU/mL, Haemophilus influenzae B IgG was less than 0.15 ug/mL, measles IgG was less than 25 AU/mL, rubella IgG was less than 1 (index), varicella zoster vaccine response was less than 135.000 (index), rubeola vaccine response was absent, and Streptococcus pneumoniae vaccine response was absent. Natural killer (NK) function was absent. A limited serum inflammatory cytokine panel showed only that soluble interleukin-2 (IL-2) receptor level was 1318 pg/mL (mildly elevated). Exome sequencing showed a heterozygous phospholipase C gamma 2 (PLCG2) variant.  The outcome of the event of vaccine induced antibody absent was not reported.  The authors considered the event of vaccine induced antibody absent as related to suspect vaccines.  A copy of the published article is attached as further documentation of the patient's experience.  This is one of two reports referring to the same literature article.  Literature Report:   Lot # is being requested and will be submitted if received.; Sender's Comments:  US-009507513-2412USA009745: