Age: 46.0
Sex: F
Vaccine: FLUX
Symptoms: CD4 lymphocytes, Drug eruption, Histology abnormal, Hypersensitivity, Immunohistochemistry
Clinical narrative: Based on the additional information received on 04 Aug 2014, this case initially considered as non-serious was upgraded to serious. Initial report received from literature on 22 July 2014. A 46-year-old female patient, whose concomitant medications were unknown, had received a dose of influenza vaccine (unknown manufacturer, dose, batch number, route and anatomical site of administration were unknown) on an unspecified date. The patient had a medical history of treated human immunodeficiency virus (HIV) disease. It was reported that the patient developed a diffuse, pruritic rash one day following vaccination against the influenza virus. Physical exam and histopathology were consistent with a lichenoid drug eruption. Corrective treatments were not reported. The outcome of the event is unknown. Documents held by sender: none. Follow up information received from literature article on 04 Aug 2014. The following verbatim obtained from article abstract: Lichenoid drug reactions to vaccinations are rare but well-documented events. The vast majority of these reported reactions have been triggered by Hepatitis B vaccination (HBV). We describe an impressive generalized lichenoid drug reaction following the influenza vaccination. A 46-year-old woman with a history of treated human immunodeficiency virus (HIV) disease developed a diffuse, pruritic rash one day following vaccination against influenza virus. Physical exam and histopathology were consistent with a lichenoid drug eruption. This is only the fifth reported case of lichenoid drug reaction, and only the second generalized case, following influenza vaccination. The patient's underlying HIV disease, known to be a risk factor for both cutaneous drug reactions and more severe manifestations of lichen planus, likely predisposed her to this generalized hypersensitivity phenomenon. The following case report obtained from the article: The patient had no history of previous reaction to drug or vaccinations of any kind. Concomitant medications included efavirenz, lamivudine, zidovudine. On physical exam, the patient had a diffuse eruption of hyperpigmented, slightly violaceous polygonal papules and plaques with white, lacy reticulations that spared her face, palms, and soles. No changes were noted on the buccal mucosa. Histopathology revealed a lichenoid interface dermatitis with eosinophils, most consistent with lichenoid drug eruption. Immunohistochemical stain for Treponema pallidium was negative. CD4 count one month prior to vaccination was normal at 706 cells/mcL. Viral load was suppressed at 128 copies/nL. The patient was treated with high potency corticosteroids, two oral prednisone tapers, and narrow band UVB therapy. While therapy was being initiated, the lesions progressed to include the face. Narrow band UVB therapy and clobetasol ointment were continued, and metronidazole 500 mg PO BID and topical tacrolimus 0.1% ointment were added to the regimen. Approximately 6 months after initiating therapy, all active lesions had resolved with marked post-inflammatory hyperpigmentation.