Age: 15.0
Sex: M
Vaccine: HPV4
Symptoms: Dermatitis psoriasiform, Diagnostic procedure, Hyperkeratosis, Hyperplasia, Lymphocytic infiltration
Clinical narrative: Information has been received from a physician concerning a 15 year old male patient who on 21-OCT-2011, was vaccinated with the first dose of GARDASIL (dose, route and lot number not reported). On 22-DEC-2011, the patient was intramuscularly vaccinated with the second 0.5 ml dose of GARDASIL, (lot number: 668262/0841AA). On 25-DEC-2011, the patient developed "pityriasis lichenoides". Lab diagnostic studies included punch biopsy on 06-JAN-2012. Treatment given for AE included steroid cream (manufacturer unknown). At the time of the report the patient's status was unknown. Follow up information has been received from the responsible physician and medical records regarding a 15 year old male (height: 70.25 inches, weight: 182 pounds) with mild intermittent asthma, seasonal allergic reaction-pollen and allergies to smoke, mold extracts (molds and smuts) and pollen extracts, who on 22-DEC-2011 was vaccinated with the second dose of GARDASIL, (lot number: 1300AA/1490AA) [previously reported as 668262/0841AA] intramuscularly in his right deltoid. The responsible physician reported that there was no illness at the time of the vaccination. Medical records indicated that on 06-JAN-2012 at 16:00, the patient was seen by the responsible physician with an all over rash. The patient reported that "around Christmas", he noticed red spots on his right upper leg which had spread to his lower abdomen, back, axilla and arms. The patient reported that over the last few days scaling and scabs had occurred. The physician reported that the patient did receive a second dose of GARDASIL a few days prior to the rash starting. The patient also did have new laundry detergent late November 2011 (was using about a month prior to rash starting) but patient changed back and rewashed all clothes "without a problem". The physician reported the patient's skin was warm and the noted rashes were 2-15 millimeter mild erythematous macular scaled lesions on the trunk and extremities. The physician's assessment was abnormality of the skin. The cause was unknown-possible GARDASIL reaction. The patient then underwent a punch biopsy from the anterior, lateral, right proximal thigh and was prescribed ZYRTEC, oral, as needed and KENALOG 0.1% topical to be applied two times daily as needed. The patient was instructed to keep the wound dry, covered for 24-48 hours and clean thereafter. On 09-JAN-2012, the physician attempted to notify the patient's parents that the biopsied specimen was sent for additional consultation. On 13-JAN-2012, the final surgical pathology consultation report was received. Noted on biopsy report was erythematous papular lesions on trunk started two days after GARDASIL vaccination, "no other known exposures." The diagnosis was: "skin, right anterior thigh-psoriasiform lichenoid dermatitis (see comment)." The sections demonstrated psoriasiform hyperplasia of the epidermis with overlying parakeratotic mounds, a superficial perivascular and somewhat band-like lymphocytic infiltrate and extravasated erythrocytes. A rare necrotic keratinocyte was present. Comment from the physician who interpreted the biopsy: "I favor a diagnosis of pityriasis lichenoides because of the psoriasiform lichenoid pattern, rare necrotic keratinocytes and extravasated erythrocytes. Pityriasis lichenoides is generally believed to be idiopathic but has been noted to occur after some infections. There are also rare reports of occurring after vaccination but I have been unable to find an association with human papilloma virus vaccine. The histological differential could less-likely include nummular dermatitis or other dermatoses." The responsible physician reported that five days after GARDASIL was administered, on 27-DEC-2011, the patient started with red spots on the right upper leg that spread to the trunk and arms with mild itching. There was partial response to triamcinolone. At the time of this report the patient's condition was unknown. The responsible physician determined that pityriasis lichenoides was an other important medical event. All available medical records will be provided upon request. Additional information has been requested.