[CIS-PAGID] E Multiforme following MMR

[Church, Joseph]

Thank you all for your input.  Joe Church

 

From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Seppänen Mikko
Sent: Tuesday, December 06, 2011 11:45 PM
To: 'pagid at list.clinimmsoc.org'
Subject: Re: [CIS-PAGID] E Multiforme following MMR

 

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 

 

206-987-7450 OFFICE

206-987-7310  FAX

allgau at u.washington.edu <mailto:allgau at u.washington.edu> , hans.ochs at seattlechildrens.org <mailto:hans.ochs at seattlechildrens.org> 

 

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Assistant:

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dawnmarie.pares at seattlechildrens.org

 

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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