Age: 0.4
Sex: M
Vaccine: DTP, HIBV, IPV, PPV, RVX
Symptoms: Abdominal pain, Alanine aminotransferase normal, Aspartate aminotransferase normal, Biopsy skin abnormal, Blister
Clinical narrative: Initial report received via a scientific literature search on 11 June 2013 via the affiliate. An unidentified 5 month old male patient was evaluated on an unreported date for raised apparently pruritic rash with episodic blisters. He was vaccinated on an unreported date with his scheduled 4 month vaccinations, including Hib; IPV; DTP and rotavirus vaccine. The vaccine manufacturers, date of vaccination, route of administration and batch numbers were not reported. Within 12 hours of vaccine administration, on an unreported date, he became colicky. A day later he began developing blisters filled with clear fluid that became confluent. The areas most affected included the back (which was covered with extensive bullae), skin fold areas of the upper arms and the lower abdomen distant from the area of injection. He had no fever and was in no acute distress. The patient history included an uncomplicated, full term pregnancy with normal delivery. At 2 months of age, the skin of his abdomen and back became progressively rough and stiff with wheal formation surrounded by "raw" red areas of flare at the site of physical stroking. A skin biopsy on an unreported date from the right flank was taken to confirm a suspected diagnosis of diffuse cutaneous mastocytosis (DCM). The patient also has a history of colicky abdominal pain. He was following his growth curve and reached all age-appropriate developmental milestones. There is no history of wheezing loss of consciousness, diarrhea, vomiting or abdominal distention. A physical examination on an unreported date showed an alert, well appearing boy in no evident distress, appropriately interactive. No lymphadenopathy or organomegaly was observed. The skin was notable for confluent skin-coloured papules and plaques with peau d'orange appearance covering his trunk with urtication on minimal touch. Hyperpigment patches of several centimeters in diameter were present on the extremities. Laboratory result on an unreported date showed a 24 hour collection urinary histamine level of 373 ug/g creatinine, total serum tryptase of 75 ng/mL and maturetryptase of 3.1 ng/mL. Blood cell counts were 12,000 white blood cell/uL, 4,690 red blood cells/uL, and 473,000 platelets/uL with mild eosinophilia of 550 cells/uL, and otherwise normal differential. Liver function tests were normal (alanine aminotransferase 23 ukat/L; aspartate aminotransferase 34 ukat/L). Lesional skin biopsy showed a patchy band-like infiltrate of mononuclear cells in the superficial dermis. Immunostaining for tryptase and CD117 was positive, confirming that the infiltrate primarily consisted of mast cells. He was treated with a 5 day course of low dose oral steroids and recovered with no residual skin changes. Since then, he has had 2 additional episodes of blistering associated with vaccination and viral illness. These episodes have become milder after initial regimen with oral and topical sodium cromolyn. The patient outcome is not recovered. Documents held by sender: None.