Sex: M
Vaccine: MMR
Symptoms: Diarrhoea, Dyspnoea, Malaise, Measles, Morbillivirus test positive
Clinical narrative: Vaccine-induced measles; Pt With Known Chronic Graft-vs-Host Disease and Recent Measles Vaccination/Recommendations would point toward postponing vaccinations,especially live-attenuating until control of chronic GVHD has been maintained without immunosuppresion for a signifi; Literature Report.   This literature marketed report has been received from the authors of a published literature article, titled as stated above, concerns a adult male patient in his forty (unspecified age at reporting time). Patient medical history included a history of a matched, sibling allogeneic stem cell transplant for diffuse large B-cell lymphoma 7 years prior and rosacea. Following the patient's stem cell transplant, he had relapsed disease 1 year later and was treated with donor lymphocyte infusion. Graft-vs-host disease (GVHD) complication of the mouth, eyes, liver, and lungs was treated with systemic steroids and tapered off. The most recent GVHD flare occurred 1 year prior to presentation, and the patient had not been undergoing immunosuppression for 6 months.  On an unknown date, the patient was vaccinated with measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live (M-M-R II) injection  (strength, dose description, lot #, expiry date and anatomical route of administration were not provided). He had received a elasomeran (MODERNA COVID-19 VACCINE)  2 months prior, and along with measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live (M-M-R II), an adjuvanted recombinant and varicella zoster vaccine rge (cho) (SHINGRIX) 1 week prior.   One week (unspecified date)after received measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live (M-M-R II) vaccination the patient presented with a generalized eruption, the diffuse rash started as pink patches on the face and spread to the trunk and extremities within 4 days. Within a day of the measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live (M-M-R II), he reported fever, chills, malaise,myalgias, loose stools, and dyspnea 7 days before the rash began. Pertinent negatives included no itch or pain associated with the rash and lack of any sclerotic skin changes. Physical examination revealed an erythematous exanthematous eruption with generalized distribution across the trunk, extremities, and face with erythematous erosions noted in the buccal mucosa of the oral cavity. Histopathology demonstrated overlapping features of cutaneous GVHD and cutaneous manifestations of measles. Within the interfollicular and follicular epidermis, there was basovacuolar change with scattered dyskeratotic keratinocytes and satellite cell necrosis, most consistent with either GVHD or measles. Within the folliculo sebaceous epithelium, rare syncytial-type multinucleated cells were seen, also consistent with measles infection. Nasopharyngeal and urine polymerase chain reaction (PCR) was positive for measles. IgM enzyme immunoassay results were positive and IgG enzyme immunoassay results were equivocal. Laboratory results showed complete blood cell count within normal limits and elevated creatinine, aspartate transaminase, alanine transaminase, ferritin, and lactate dehydrogenase levels. The infectious workup showed positive results for SARS-CoV-2 IgG and IgA receptor-binding domain. The authors stated that this case represented a rare case of vaccine induced measles (Measles post vaccine). In addition, current recommendations would point toward postponing vaccinations,especiallylive-attenuating, until control of chronic GVHD had been maintained without immunosuppression for a significant duration, even more than 2 years (Contraindicated product administered).   The patient's eruption and symptoms resolved with supportive care alone, without any immunosuppression (recovered).  The authors considered the event Measles post vaccine to be related to measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live (M-M-R II).   Lot number is being requested and will be submitted if received.  A copy of the published article is attached as further documentation of the patient's experience.