Vol.72 No.4 July 2024

A case of subcutaneous fat tissue inflammation following vaccination with the 23-valent pneumococcal polysaccharide vaccine

Hidenori Takahashi^{1, 2)}, Mio Toyama-Kousaka¹⁾, Shinichiro Ota¹⁾, Syunsuke Takano²⁾, Suzuko Fukasawa²⁾, Kaeyoung Park²⁾, Takahiko Yano²⁾, Hiroshi Arakawa³⁾ and Masaharu Shinkai¹⁾

¹⁾Department of Respiratory Medicine, Tokyo Shinagawa Hospital, 6-3-22 Higashioi, Shinagawa-ku, Tokyo, Japan
²⁾Department of Infection Control, Tokyo Shinagawa Hospital
³⁾Department of Dermatology, Tokyo Shinagawa Hospital

Abstract

A 75-year-old woman who was undergoing outpatient treatment with erythromycin for bronchiectasis received her second dose of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) in her left upper arm. Two days after the vaccination, she developed fever, chills, and swelling with redness at the injection site, prompting her to seek emergency care due to concerns about vaccine-related adverse effects. Clinical examination revealed fever (body temperature 37.4°C) and a fist-sized area of indistinct redness and swelling on the outer aspect of the left upper arm. A CT examination showed opacification of the subcutaneous fat, and the patient was hospitalized and treated with intravenous ceftriaxone and topical steroids. Although initially within normal range, her serum C-reactive protein (CRP) level rose to 7.72 mg/dL two days post-admission, along with an increase in the arm swelling size of the induration in the arm, both of which later improved. She was discharged about a week later and showed complete recovery at the follow-up visit one week post-discharge. In view of the negative blood cultures and a clinical course not suggestive of infection, the patient was diagnosed as having developed a vaccine-related cellulitis-like reaction, and her case was recognized recommended for compensation under the health damage relief system.
This reaction, considered as a Type III allergic reaction to the administered antigen, represents a delayed-onset condition reaction that can improve with conservative treatment. Although rare, with over 300 reported cases, the diagnosis can be challenging as it can resemble soft tissue infection. Thus, it is important to explain about the vaccine and its potential adverse effects to patients at the time of vaccination and ensure appropriate management in the event of development of symptoms.

Key word

adverse event, cellulitis, pneumococcal vaccine, vaccination

Received

February 19, 2024

Accepted

May 8, 2024

Jpn. J. Chemother. 72 (4): 358-363, 2024