[CIS-PAGID] E Multiforme following MMR

[Seppänen Mikko]

In infectious diseases in general, EMultif is often induced by a drug/vaccine that is given during an ongoing infection, thus there are usually 2 concurrent inciting factors. Common scenario in adults is the use of older symptomatic flu drugs against flu.
Studies show that the infection is often HSV1 (or HSV2). Herpes genome can even often be found intracellularly, within the lesion. In recurrent EMultif if there is no clear drug re-exposure, in up to about 90% of cases the patient is HSV-1 (/2) carrier, and in these cases prophylactic long-term acyclovir/valaciclovir gets the patient into remission. (In acute EMultif, antivirals do not help, it takes 3-15 days for a HSV reactivation to induce EMultif, thus the drug is there always too late.)

My guess is that the child could very well be an HSV1-carrier. If absolutely necessary to give a second dose, I would check S-HSV-1-Abs (with Elisa), and IF the child tests positive, hypothetically the risk MIGHT be lower during acyclovir prophylaxis, but as already noted there is very little data to rely on in this scenario. Was there a preceding clinical labial herpes (need not be symptomatic, though)? Check the levels of specific Abs and vaccinate only if absolutely necessary?

mikko

__________________________________________________
Mikko Seppänen, MD, PhD
Specialist in Internal Medicine and Infectious Diseases
Senior Consultant, Physician in charge (PIDD)
EM(E)A Expert, PIDDs and Intravenous Immunoglobulin Therapy

Immunodeficiency Unit
Division of Infectious Diseases
Department of Medicine
Helsinki University Central Hospital
Hospital District of Helsinki and Uusimaa
Aurora Hospital, Ward 4-2 and Outpatient Clinic
P.O.Box 348
FI-00029 HUS, Helsinki
FINLAND
phone +358 9 47175923, fax +358 9 47175945
_________________________________________

Lähettäjä: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] Puolesta Aly.Mageed at helendevoschildrens.org
Lähetetty: 6. joulukuuta 2011 22:27
Vastaanottaja: pagid at list.clinimmsoc.org
Aihe: Re: [CIS-PAGID] E Multiforme following MMR

My son had a localized strange rash behind his ears after MMR that was kind of purpuric/hemorrhagic and later became almost necrotic and peeled off.  We thought then (15 years ago) of E M but did not truly fit. Upon revaccination later, he developed JRA 2-3 weeks post. No more MMR were given!

Aly Mageed, MD
Division Chief, Pediatric Blood & Marrow Transplant
Helen DeVos Children's Hospital and Michigan State University
(616)-391-3962
aly.mageed at helendevoschildrens.org



From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Ochs, Hans
Sent: Tuesday, December 06, 2011 2:24 PM
To: 'pagid at list.clinimmsoc.org'
Subject: Re: [CIS-PAGID] E Multiforme following MMR

Joe, this is unknown territory.
I agree with your assessment, but if his child gets another MMR, let the CIS member know! It could be quite a story
hans

Hans D. Ochs, MD, Dr. med
Professor of Pediatrics | Jeffrey Modell Chair of Pediatric Immunology Research
Center for Immunity and Immunotherapies
Seattle Children's Research Institute | University of Washington

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From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Church, Joseph
Sent: Tuesday, December 06, 2011 7:13 AM
To: pagid at list.clinimmsoc.org
Subject: [CIS-PAGID] E Multiforme following MMR

Colleagues:
I was asked to see a 12 month old child who developed Erythema Multiforme after receiving an MMR vaccine.

This has been reported previously (Acta Derm Venereol 2006;86:359-60).  However, there are no reports that I could find that describe whether the recommended second dose of MMR was ever given.

My plan is to treat this reaction as if the MMR were a drug and avoid future exposures to the vaccine.

Any thoughts on this would be greatly appreciated.

Joe Church, MD
Children's Hospital Los Angeles

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