Severe pancytopenia triggered by recombinant hepatitis B vaccine.
We describe the case of a teenager who developed fever, arthritis, cutaneous vasculitis and severe pancytopenia 3 weeks after the third vaccination boost with a recombinant hepatitis B vaccine. Bone marrow examination showed paucity of late myeloid elements and, subsequently, maturation arrest. Interferon-gamma (IFN-gamma) production by peripheral blood mononuclear cells from the patient was dramatically increased. An underlying immune predisposition (HLA-DR3) may have indirectly enabled the vaccine to trigger a hepatitis B virus-specific cytotoxic T-lymphocyte response. It is therefore possible that the pancytopenia was induced by a dysregulation of the CD8+ T-cell compartment via increased IFN-gamma production.
Viallard
J F
JF
Clinique de Médecine Interne et Maladies Infectieuses, Service d'Hématologie, Laboratoire d'Anatomopathologie, Hôpital Haut-Lévêque, Pessac, France. JF.viallard@umr5540.u-bordeaux2.fr
Boiron
J M
JM
Parrens
M
M
Moreau
J F
JF
Ranchin
V
V
Reiffers
J
J
Leng
B
B
Pellegrin
J L
JL
D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D005260:Female; D017325:Hepatitis B Vaccines / Q000009:adverse effects*; D006801:Humans; D007371:Interferon-gamma / Q000096:biosynthesis; D016753:Interleukin-10 / Q000096:biosynthesis; D018664:Interleukin-12 / Q000096:biosynthesis; D007376:Interleukin-2 / Q000096:biosynthesis; D010198:Pancytopenia / Q000139:chemically induced* / Q000276:immunology; D013601:T-Lymphocytes / Q000187:drug effects / Q000276:immunology; D014614:Vaccines, Synthetic / Q000009:adverse effects*
D017325:Hepatitis B Vaccines; D007376:Interleukin-2; D014614:Vaccines, Synthetic; D016753:Interleukin-10; D018664:Interleukin-12; D007371:Interferon-gamma