Age: 1.1
Sex: F
Vaccine: HIBV, MMR, PPV
Symptoms: Skin plaque
Clinical narrative: Initial unsolicited report received from the literature on 11 October 2015. The following is verbatim from the article: Abstract: We report on a 13-month old girl who presented to the Dermatology Clinic with erythematous vesicular plaques consistent with IP after receiving her 12-month immunizations (MMR; Hib; and PCV) on December 11, 2012. In the 2 weeks after immunization, erythematous, vesicular plaques developed on her left hand and right foot. The first vesiculobullous lesions to appear had, according to the mother's report, subsequently transformed into verrucous papules. According to the patient's mother, her previous immunizations had not resulted in similar lesions. The mother also denied that the patient had recent infections or fevers. Examination of the left thigh and flank found slightly hyperpigmented, whorled patches, with prominent vasculature. No diagnostic tests were ordered because she already carried a biopsy-supported diagnosis of IP completed at birth, and the classic appearance of the reactivation lesions was sufficient to make the diagnosis. 4 Reactivation of IP after 12-month immunizations was diagnosed. As a neonate, her initial IP lesions involved the left thigh, extending to the groin, and her left flank. After the vesiculobullous stage, she maintained stable whorled hyperpigmented patches for months, with slightly atrophic areas interspersed with prominent vasculature. Mild ocular findings were noted, which were checked regularly by the patient's ophthalmologist. The patient's mother had a personal history of IP and currently presents with both hyper- and hypopigmented patches on her torso and left thigh. This case involves a 13-months-old female patient who was vaccinated with a dose of HIB (manufacturer: unknown); MMR (manufacturer: unknown); and a dose of PCV (manufacturer: other) (batch number, dose, dose in series, route and site of administration were not reported for all) on 11 December 2012. The patient's medical history included incontinentia pigmenti (IP) which involved left thigh, extending to the groin, and her left flank. Family history included incontinentia pigmenti (IP) and currently presents with both hyper and hypopigmented patches on her torso and left thigh. The patient had previously received vaccines for immunization. Concomitant medications were not reported. On an unknown date, two weeks following the vaccination, the patient had developed erythematous, vesicular plaques on her left hand and right foot; the vesiculobullous lesions transformed to verrucous papules. On an unknown date, following the vaccination, the patient's left thigh and flank found slightly hyperpigmented, whorled patches, with prominent vasculature/ whorled hyperpigmented patches for months. It was reported that the patient carried a biopsy-supported diagnosis of IP completed at birth, and classic appearance of the reactivation lesions was sufficient to make the diagnosis. Relevant laboratory test reported as none. Corrective treatment was not reported. The outcome of the events were not reported. Upon medical review, the case was considered as serious due to important medical event: IP (incontinentia pigmenti) / she already carried a biopsy-supported diagnosis of IP completed at birth, and the classic appearance of the reactivation lesions was sufficient to make the diagnosis. Documents held by sender: none.