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CASE REPORT
Year : 2022 | Volume
: 26
| Issue : 3 | Page : 1-2
Vaccine induced mastocytoma
Anwar Alramthan, Laila Ashour, Mohammed Alenezi
Department of Dermatology, Ministry of Health, Al-Amiri Hospital, Kuwait City, Kuwait
Correspondence Address:
Dr. Anwar Alramthan
P.O. Box 49185, Omariya, Kuwait City
Kuwait
Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jdds.jdds_34_21
Mastocytoma has been reported to appear in close temporal or spatial relationship to intramuscular injection of Hepatitis B vaccine. Here, we report a case of isolated vaccine induced mastocytoma occurring in an 8-month-old female patient.
Keywords: Hepatitis B, mastocytoma, vaccination
Mastocytosis is an abnormal mast cell proliferation that may represent a reactive or neoplastic process. Trauma has been implicated as a trigger of cutaneous mastocytoma as well as intra-musical administration of hepatitis B vaccine. Here, we report a case of solitary cutaneous mastocytoma occurring at the site of intramuscular injection of various vaccine including hepatitis B vaccine.
Case ReportWe are reporting a case of solitary mastocytoma induced by vaccination in an 8-month-old female. The patient received an intramuscular injection of the third dose of hepatitis B vaccine, Haemophilus influenzae vaccine as well as diphtheria, pertussis, and tetanus vaccine. After 1 week, a skin lesion appeared exactly on the injection site, which was the anterior superior aspect of the left thigh. The lesion was excised and discarded without histopathological evaluation. Six weeks later, a tiny lump appeared on the excision site that gradually increased in size. The recurrent lesion resembled the initial lesion. On examination, there was a 3 cm × 1.5 cm red, indurated plaque with a rough peau d orange surface on the anterior aspect of the left thigh [Figure 1]a. The lesion turned more red on rubbing [Figure 1]b. The lesion was biopsied using a 3-mm punch. Tissue analysis revealed mild epidermal spongiosis, heavy cellular infiltrate in the papillary dermis with a positive CD117 and mast cell tyrosinase immunostaining, as well as a mild perivascular lymphocytic cell infiltrate [Figure 2]a, [Figure 2]b, [Figure 2]c, [Figure 2]d. The features were diagnostic of mastocytoma. A detailed history was retrieved from the parents. The child had an uncomplicated full-term pregnancy with normal vaginal delivery at 38 weeks and had an unremarkable past medical history before the vaccination event at the age of 6 months. The mother denied any trauma, family history of mastocytosis, or other skin diseases. The patient was treated with topical mometasone furoate 0.1% ointment once daily. Follow up appointment was scheduled two weeks later, cutaneous examination revealed complete resolution of lesion. The parents were reassured that this condition is self-limiting and that the prescribed topical steroid would be safe and for symptomatic relief.
Figure 1: As a 3 × 1.5 cm red, indurated plaque with a rough peau d'orange surface on anterior aspect of the left thigh (a). The lesion turned more red on rubbing (b)
Figure 2: Mild epidermal spongiosis, heavy cellular infiltrate in the papillary dermis and mild perivascular lymphocytic cell infiltrate (a and b high magnification), positive CD117 immunostaining (c), positive mast cell tyrosinase immunostaining (d) Discussion Mastocytoma typically presents as an indurated, erythematous, yellow-tan to red-brown macule, papule, plaque, or nodule, usually measuring up to 5 cm in diameter.[1],[2] The lesion often has a peau d'orange appearance and a leathery texture.[1] Most mastocytomas favor the distal extremities.[2] Occasionally, more than one mastocytoma can be found.[2] Mastocytomas may urticate spontaneously or when rubbed.[1] Organomegaly, lymphadenopathy, and other forms of systemic involvement are characteristically absent.[1] These lesions can be congenital or become evident during the first 2 years of life.[1],[2] In many cases, the lesions spontaneously involute before puberty.[1],[2] Treatment is mainly symptomatic.[1],[2]
Mastocytosis is an abnormal mast cell proliferation involving various organs.[3] The underlying pathogenesis may represent a hyperplastic or neoplastic process.[4] A mutation in the KIT gene re in proliferation and activation of mast cells.[3] Although the KIT mutation is typically found in adult-onset mastocytosis, a recent study has documented that pediatric solitary mastocytoma is frequently associated with KIT-activating mutations, in keeping with a clonal process.[3] On the other hand, the transient and self-limiting nature of the disease is suggesting that it is a temporary response to an abnormal stimulus.[4]
This case developed a solitary cutaneous mastocytoma at the site of intramuscular injection of various vaccines supporting the theory that mastocytosis is a reactive process. Hepatitis B vaccine was among the injected vaccines. Mastocytoma has been reported to appear in close temporal or spatial relationship to intramuscular injection of hepatitis B vaccine.[5],[6] Trauma has also been implicated as a trigger of cutaneous mastocytoma.[7] It is debatable whether the trigger of mastocytoma was the induced trauma or the vaccine material. The previously reported cases, in addition to the one we are reporting, shared one factor in common that is trauma. However, three of four cases were associated with hepatitis B vaccine. The role of hepatitis B vaccine as a trigger for cutaneous mastocytoma cannot be overlooked.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
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