Age: 1.0
Sex: F
Vaccine: MMR, MMRV
Symptoms: Immunisation reaction, Immunoglobulin therapy, Immunosuppressant drug therapy, Multiple-drug resistance, Necrosis
Clinical narrative: cutaneous granulomatous disease associated with rubella virus/virus. Vaccine-derived RuV; This literature marketed report has been received from the authors of a published literature article, titled as stated above, concerning a 4-year-old female patient who was vaccinated with two doses of measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live (manufacturer unknown) injection, administered for prophylaxis (strength, lot number, expiration date, and route of administration were not provided) when she was 1-year-old; then she was vaccinated with measles, mumps, rubella and varicella (oka-merck) virus vaccine live (manufacturer unknown) injection, administered for prophylaxis (strength, dose description, lot number, expiration date, and route of administration were not provided) when she was 4-years-old.  On unspecified date, the patient started experiencing eyelid disease severe, therefore partial excisional biopsy of the right inferior eyelid was performed by an oculoplastic surgeon and showed suppurative and granulomatous inflammation. The patient presented cutaneous granulomatous disease (Granuloma).  Her disease remained refractory to topical erythromycin ointment and combination topical dexamethasone, neomycin and polymyxin B ointment, courses of oral antibiotics including clindamycin, amoxicillin and clavulanate, azithromycin, and a 4-week trial of oral prednisone (1 mg/kg/day). Surgical management included tissue debridement. Her ocular disease continued to progress to involve the right inferior conjunctiva with a new nodule involving the left superior medial eyelid Due to concern for visionthreatening disease, she was admitted for multidisciplinary management. Inpatient management included serial eye exams under anesthesia, initially performed daily, to remove copious purulent discharge, which was suspected to be a contributing factor to her focal areas of eyelid and conjunctival necrosis. Other treatments for the event were: sarcoidosis was used as a prototype for therapy. Initial therapy included 6 days of 30 mg/kg/day of methylprednisolone and IVIG 500 mg/kg once, with the subsequent addition of infliximab 5 mg/kg on weeks 0, 2, and then every 4 weeks, and methotrexate 15 mg weekly for more targeted immunosuppression. Dapsone 2 mg/kg/day was also added. For anti-viral therapy, oral ribavirin and nitazoxanide. The patient's ocular clinical findings responded well throughout her 4-week hospital course. She remained without recurrence after hospital discharge on maintenance infliximab 5 mg/kg every 4 weeks and methotrexate 15 mg once weekly, with plan for 3 years of treatment post remission. She underwent successful surgical reconstruction 1 year after her initial clinical presentation.  The author considered the event granuloma to be related to both suspect vaccines.  Upon internal review, the event Granuloma has been determined to be medically significant.  This is one of 2 reports received from the same literature article.  A copy of the published article is attached as further documentation of the patient's experience.  Literature report: