Sex: M
Vaccine: HEP, HEPA
Symptoms: Rash pruritic, Urine analysis normal, Vasculitis, White blood cell count increased
Clinical narrative: leukocytoclastic vasculitis; Henoch Schonlein purpura/consistent with IgA vasculitis; neutrophil-predominant dermatitis; mildly itchy rash; abdominal pain; nausea; diarrhea; low-grade fever; joint aches; This case was reported in a literature article and described the occurrence of leukocytoclastic vasculitis in a 59-year-old male patient who received Hepatitis A vaccine for prophylaxis.  Co-suspect products included Hepatitis B vaccine for prophylaxis.   On an unknown date, the patient received Hepatitis A vaccine at an unknown dose and Hepatitis B vaccine at an unknown dose. On an unknown date, 3 days after receiving Hepatitis A vaccine and Hepatitis B vaccine, the patient experienced leukocytoclastic vasculitis (serious criteria GSK medically significant), henoch-schonlein purpura, itchy rash, abdominal pain, nausea, diarrhea, fever, joint pain and dermatitis. The patient was treated with doxycycline and prednisone. On an unknown date, the outcome of the leukocytoclastic vasculitis, henoch-schonlein purpura and dermatitis were unknown and the outcome of the itchy rash, abdominal pain, nausea, diarrhea, fever and joint pain were recovered/resolved.   The reporter considered the leukocytoclastic vasculitis, henoch-schonlein purpura, itchy rash, abdominal pain, nausea, diarrhea, fever, joint pain and dermatitis to be possibly related to Hepatitis A vaccine and Hepatitis B vaccine.  Additional details were provided as follows: This case was reported in a literature and described the occurrence of henoch schonlein purpura in a 59-year-old male patient who was vaccinated with unspecified hepatitis A vaccine and unspecified hepatitis B vaccine (manufacturer unknown for both) for prophylaxis. No information on patient's medical history, family history, concurrent condition or concomitant medication was provided. On an unspecified date, the patient received unspecified hepatitis A vaccine and unspecified hepatitis B vaccine (administration route and site unspecified, dosage unknown; batch number not provided for both). The age of vaccination was not provided for both but it could be 58 or 59 years. On an unspecified date, 3 days after the vaccinations, the patient developed mildly itchy rash on the lower extremities and buttocks associated with abdominal pain, nausea and diarrhea, low-grade fever and joint aches and presented with 3 weeks history of these symptoms. An abdominal pain evaluation was performed by his primary care physician that included the following normal tests: comprehensive metabolic panel, amylase, lipase and computerized tomography (CT) scan of the abdomen. Complete blood count (CBC) revealed a slightly elevated white blood cell (WBC) of 11.4 with 81.2% neutrophils. The patient was started on doxycycline due to concern for Rocky Mountain Spotted Fever. On examination, the patient had widespread palpable purpura involving the lower extremities, buttocks, groin, lower abdomen, lower back and upper extremities. Biopsies for routine processing and direct immunofluorescence (DIF) were taken. A urinalysis was performed and was negative for blood and protein. Hepatitis panel was negative. Biopsy revealed perivascular and interstitial neutrophil-predominant dermatitis with focal fibrin deposition in small vessels consistent with leukocytoclastic vasculitis. DIF revealed 2-3+ granular Immunoglobulin (IgA) deposition in several superficial dermal blood vessels consistent with IgA vasculitis. The patient was improved with prednisone but flared upon its discontinuation. The patient was restarted on prednisone with plan to initiate dapsone as a steroid-sparing agent. His urinalysis will be followed for abnormalities. Authors commented, "To our knowledge, this is the first case of Henoch-Schonlein purpura arising in an adult after administration of hepatitis A vaccine and one of only few reported cases of HSP following hepatitis B vaccine. This case highlights the possible role vaccinations may play in the trigger of HSP and emphasizes the importance of taking a detailed history from the patient as well as keeping track of the health care issues affecting your local community. Since one of the hepatitis vaccines is presumed to be the triggering factor for this patient's disease, we caution against completion of this series of vaccinations."      Lab Comments: On an unspecified date lab test were performed. The patient performed comprehensive metabolic panel, amylase, lipase and computerized tomography (CT) scan of the abdomen result not provided. Biopsy revealed perivascular and interstitial neutrophil-predominant dermatitis with focal fibrin deposition in small vessels consistent with leukocytoclastic vasculitis.