Age: 53.0
Sex: M
Vaccine: VARZOS
Symptoms: Aspiration bone marrow normal, Benign lymph node neoplasm, Biopsy bone marrow normal, Biopsy lymph gland normal, Biopsy skin abnormal
Clinical narrative: primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder; red lesion started to form in the stomach; lesion started to form in the stomach and itched; Pseudolymphoma; lymph node of mild concern; lymphnode benign; suspicious of an Atypical T-cell infiltrate; This case was reported by a consumer and described the occurrence of lymphoproliferative disorder in a adult male patient who received Herpes zoster (Shingrix) for prophylaxis.   On 9th August 2019, the patient received the 1st dose of Shingrix. In September 2019, less than 2 months after receiving Shingrix, the patient experienced lymphoproliferative disorder (serious criteria GSK medically significant), skin lesion, pruritus, pseudolymphoma, lymph node disorder, benign lymph node neoplasm and lymphocytic infiltration. The patient was treated with topical antibiotic (nos) (Antibiotic Cream (Nos)). On an unknown date, the outcome of the lymphoproliferative disorder, skin lesion, pruritus, pseudolymphoma, lymph node disorder, benign lymph node neoplasm and lymphocytic infiltration were unknown.   The reporter considered the lymphoproliferative disorder, skin lesion, pruritus, pseudolymphoma, lymph node disorder, benign lymph node neoplasm and lymphocytic infiltration to be related to Shingrix.  Additional details were provided as follows: The patient was self reporting what he believed dould be a side effect from Shingrix. Four to 5 weeks after the vaccination, the patient thought that could have have received an insect bite to stomach as a red lesion started to form and it itched. The patient had punch biopsy with a result of suspicious for an atypical T-cell infiltrate. The patient preformed blood test with normal result and performed PET scan which showed one lymph node of mild concern which later tested benign after removal and biopsy as per oncologist suggested. The patient had concurrent flow cytometry with no immunophenotypic evidence of a clonal cell population and bone marrow biopsy or aspiration with no changes of concern for lymphoma. The patient had entire lesion excised from the stomach and was biopsied, it showed similar features to the punch biopsy by morphology and immunohistochemistry. Till the time of reporting the lesions did not go away and requested that a doctor look at it. The doctor prescribed a topical antibiotic cream and after 5 days the patient did not notice a change in the lesion, so the patient had requested a dermatologist examine it and took a punch biopsy and was subsequently referred to an oncologist. The patient reported that, the oncology and pathology departments have diagnosed condition as a primary cutaneous CD4+ small or medium T-cell lymphoproliferative disorder. The patient asked if, it was possible that the Shingrix vaccine caused the lesion (pseudolymphoma) and should get 2nd dose of Shingrix as currently due for 2nd dose. The patient also asked if there were other similar cases to what had experienced. The reporter consented to follow up to get a sense of whether this was a disorder that needed to worry about for the rest of life or was it more likely that this was a reaction to the vaccine.      Lab Comments: The punch biopsy result was suspicious for an Atypical T-cell infiltrate. The entire lesion was excised from the stomach and was biopsied. It showed similar features to the punch biopsy by morphology and immunohistochemistry. The concurrent flow cytometry shows no immunophenotypic evidence of a clonal cell population. The PET scan which showed one lymphnode of mild concern which later tested benign after removal and biopsy.