Age: 1.0
Sex: F
Vaccine: HIBV, MMR, PPV, TTOX
Symptoms: Antibody test negative, Biopsy skin abnormal, Erythema, Gene mutation identification test positive, Granuloma
Clinical narrative: the patient was positive for vaccine-derived rubella virus (VDRV); Antibody titers demonstrated immunity to MMR, but low immunity to Streptococcuspneumoniae,Haemophilus influenzae,andtetanus toxoid despite the patient receiving these vaccinesonschedule.; the patient was immunodeficiency and received measles, mumps, and rubella (MMR) vaccine; This literature market report has been received from authors of a published article, referring to a 12 months old female patient with cutaneous granulomatous disease and immunodeficiency. The patient's medical history and concomitant medication were not provided.   On an unknown date when the patient was 12 months old, the patient was vaccinated with measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live (manufacturer unknown) for prophylaxis (product use issue). On an unknown date, the patient was vaccinated with pneumococcal vaccine, polyvalent (23-valent) (manufacturer unknown), haemophilus b conjugate vaccine (meningococcal protein conjugate) (manufacturer unknown) and tetanus toxoid on schedule for prophylaxis. The strength, dose, route, batch/lot number and expiration date were not provided for the above products.      On an unknown date when the patient was 1.5 years old (reported as 1 year history), the patient presented with skin eruption. The patient was otherwise healthy. On an unknown date a few months after the vaccination of measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live (manufacturer unknown), the patient had red papules erupted on her legs. Histopathologic analysis showed sarcoidal granulomas. Test results for systemic sarcoidosis were negative, and the patient was lost to follow-up until age 10 years. At that time, biopsies again showed sarcoidal granulomas, but test results for systemic sarcoidosis were again negative. Genetic evaluation found a NOD2 mutation, c2104C more than T(pArg702Trp), associated wi th increased risk of Crohn disease. The patient had no clinical features of Blau syndrome, early-onset sarcoidosis, or Crohndisease. The biopsy specimen tested strongly positive for rubella by immunohistochemical analysis(vaccine-derivedrubella virus (VDRV)). A nasopharyngeal swab tested negative for rubella virus. Antibody titers demonstrated immunity to measles, mumps, and rubella (MMR), but low immunity to streptococcuspneumoniae, Haemophilus influenzae, and tetanus toxoid despite the patient receiving these vaccines on schedule (antibody test negative). The outcome of VDRV and low immunity to streptococcuspneumoniae, Haemophilus influenzae and tetanus toxoid was unknown. The reporter considered VDRV was related to all suspect products. The reporter considered low immunity to streptococcuspneumoniae, Haemophilus influenzae, and tetanus toxoid was related to all suspect products except measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live (manufacturer unknown). The causality between low immunity to streptococcuspneumoniae, Haemophilus influenzae and tetanus toxoid and measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live (manufacturer unknown) was not reported.   A copy of the published article is attached as further documentation of the patient's experience.   This is one of two reports regarding the same literature (linked case# 1908USA004317).; Sender's Comments:  US-009507513-1908USA004317: