Generalized granuloma annulare after pneumococcal vaccination

Abstract

Granuloma annulare may be caused by multiple triggers. Among these are vaccinations, which have been described as an infrequent cause of granuloma annulare. The authors report the first case of generalized granuloma annulare associated with pneumococcal vaccination in a 57-year-old woman, who presented cutaneous lesions 12 days after vaccination.

Granuloma Annulare: An Updated Review of Epidemiology, Pathogenesis, and Treatment Options

“…In January 2021, Shah et al reviewed granulomatous cutaneous drug eruptions and identified a number of iatrogenic causes of GA: allopurinol, amlodipine, anti-TNFα agents (infliximab, adalimumab, etanercept, and thalidomide), botulinum toxin, dabrafenib, desensitization injections, immune checkpoint inhibitors, intranasal calcitonin, gold, immunizations (hepatitis B and anti-tetanus vaccination), levetiracetam, paroxetine, pegylated IFNα, secukinumab, tocilizumab, topiramate, and vemurafenib [ 49 ]. More recently, acetazolamide [ 50 ], apremilast [ 51 ], ixekizumab [ 52 ], mesotherapy [ 53 ], phototherapy [ 54 ], and measles, mumps, and rubella (MMR) [ 55 ], pneumococcal [ 56 ], and VZV [ 57 ] immunizations have also been implicated in instigating GA. The pathogenesis of drug-induced GA is not easily understood, and the induction of GA by anti-TNFα agents and apremilast in particular is paradoxical, as both TNFα inhibitors and apremilast have also been reported as effective therapies for GA. Instigation of GA by IL-17 inhibitors (ixekizumab and secukinumab) is also intriguing, as Min et al reported hyperactivation of the Th17 axis in GA. We attempt to explain these paradoxical observations in Sect.…”

“…More recently, acetazolamide [ 50 ], apremilast [ 51 ], ixekizumab [ 52 ], mesotherapy [ 53 ], phototherapy [ 54 ], and MMR [ 55 ], pneumococcal [ 56 ], and VZV [ 57 ] immunization have also been reported…”

Resolution of refractory generalized granuloma annulare after treatment with alitretinoin

“…Activation of T cell–mediated immune response is thought to be the pathologic mechanism of GGA. 3 In this case of GGA, there was no definite cause of the disease. The history of malignancy may have had an impact, but it is known that myeloid leukemias are less commonly associated with GGA compared to other lymphomas.…”

A Case Report of ChAdOx1 nCoV- 19 Corona Virus Recombinant Vaccine Related Granuloma Annulare

“…Immunological activation following vaccination may explain the presence of activated T-cells in the lymphocytic infiltrate in the palisading granulomas. There is a lesser possibility of traumatic inoculation hypothesis, as the site of granuloma formation is distant and hence less convincing [8].…”

“…Several vaccines have been reported to trigger GA [5]. Bacillus Calmette-Guérin (BCG) vaccine has been most frequently reported [4], followed by the hepatitis B vaccine, influenza vaccine, tetanus and diphtheria-tetanus toxoid vaccine and pneumococcal vaccine [11]. GA after SARS-CoV-2 vaccination has not been previously described.…”