Infections or Vaccines Associated with Finkelstein-Seidlmayer Vasculitis: Systematic Review

The possible existence of an infectious or a vaccine precursor was addressed in 447 cases and not addressed in the remaining 57 cases (Fig. 2). Cases with this piece of information were slightly younger than cases without it (11 [8,9,10,11,12,13,14,15,16,17,18] months of age vs 14 [9,10,11,12,13,14,15,16,17,18,19,20,21] months of age, P < 0.05). The male-to-female ratio was similar in the two groups (309 boys and 138 girls, respectively, 40 boys and 17 girls). Most cases were preceded by an infection (86%), by a vaccination (4.4%), or both an infection and a vaccination (3.8%). No precursor was reported in the remaining cases (5.8%). Two distinct infections preceded the onset of the skin eruptions in 11 of the 384 cases with infection-associated Finkelstein-Seidlmayer vasculitis.

Fig. 2figure 2

Finkelstein-Seidlmayer vasculitis. Precursors. The term AHEBID denotes the Acute Hemorrhagic Edema BIbliographic Database

The 449 precursors noted in 423 infants are given in Fig. 3. Most cases were preceded by an upper respiratory tract infection (65%), followed by a vaccine (8.2%), a gastroenteritis (8.9%), a benign febrile infection (8.0%) or a lower respiratory infection (4.9%).

Fig. 3figure 3

Infectious or vaccine precursors noted in 423 patients with Finkelstein-Seidlmayer vasculitis

Ninety-seven microorganisms possibly causing the infectious precursor were detected in 85 infants: 54 bacteria, 41 viruses, and 2 fungi (Table 2).

Table 2 Microorganisms (N = 97) associated with the infectious precursor in 85 patients (65 males and 20 females; 10 [7,8,9,10,11,12,13,14] months of age) with Finkelstein-Seidlmayer vasculitis

The temporal relationship between the infectious precursor and the onset of the skin eruption was not detailed in 65 cases (47 boys and 18 girls, 11 [8,9,10,11,12,13,14,15,16,17,18] months of age). This parameter was reported in the remaining 336 cases (230 boys and 106 girls, 11 [8,9,10,11,12,13,14,15,16,17] months of age). Fifty-three cases (38 boys and 15 girls, 11 [7,8,9,10,11,12,13,14] months of age) were intra- and 283 (191 boys and 92 girls, 11 [8,9,10,11,12,13,14,15,16,17] months of age) post-infectious (Table 3). The latency time was significantly lower in the 23 intra-infectious cases (P < 0.001) as compared with the 205 post-infectious cases.

Table 3 Characteristics of patients with post- or intra-infectious Finkelstein-Seidlmayer vasculitis. Data are given as median and interquartile range or as frequency

In 37 cases (24 males and 13 females, 12 [7,8,9,10,11,12,13,14,15,16,17,18] months of age), the skin eruptions were preceded by one or more active immunizations (Table 4). The temporal relationship between the vaccination and the onset of this vasculitis was not described in 10 cases (8 boys and 2 girls, 17 [8,9,10,11,12,13,14,15,16,17,18,19,20] months of age). The latency time was 7 [3,4,5,6,7,8,9,10,11,12,13] days in the remaining 27 cases (16 boys and 11 girls, 12 [7,8,9,10,11,12,13,14,15,16,17,18] months of age).

Table 4 Immunizations (N = 103) potentially implicated in 42 cases of Finkelstein-Seidlmayer vasculitis (29 males and 13 females, 12 [7,8,9,10,11,12,13,14,15,16,17,18] months of age). The vast majority of the 42 cases were administered a combination vaccine

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