title: Wells' syndrome following thiomersal-containing vaccinations.
abstract: A 3 1/2-year-old boy presented on three occasions with painful, itchy, oedematous plaques on his limbs. On two occasions he had received hepatitis B vaccination 11-13 days previously, and on the third occasion received triple antigen (DTP) vaccination 10 days earlier. Skin biopsy revealed a prominent infiltrate of eosinophils involving the entire thickness of the dermis. In addition there were prominent 'flame figures' consisting of eosinophilic necrotic collagen surrounded by granular basophilic debris. The clinical and histological pictures were consistent with Wells' syndrome. The eruption settled on the second and third occasions with 0.1% mometasone furoate cream. Subsequent patch testing showed 2+ reaction to preservative thiomersal at 96 hours. This is the first description of Wells' syndrome with typical clinical and histopathological features associated with thiomersal in two different vaccines.
authors.affiliation: Department of Dermatology, Women's and Children's Hospital, North Adelaide, South Australia, Australia.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Koh
authors.forename: Lachlan
authors.initials: L
authors.lastname: Warren
authors.forename: Lynette
authors.initials: L
authors.lastname: Moore
authors.forename: Craig
authors.initials: C
authors.lastname: James
authors.forename: Geoffrey N
authors.initials: GN
authors.lastname: Thompson
mesh_terms: D000287:Administration, Topical; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001706:Biopsy; D002481:Cellulitis / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology; D002675:Child, Preschool; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000008:administration & dosage; D004802:Eosinophilia / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology; D005938:Glucocorticoids; D017325:Hepatitis B Vaccines / Q000008:administration & dosage; D006801:Humans; D008297:Male; D000068656:Mometasone Furoate; D011244:Pregnadienediols / Q000627:therapeutic use; D011310:Preservatives, Pharmaceutical / Q000009:adverse effects*; D012867:Skin / Q000473:pathology; D013577:Syndrome; D013849:Thimerosal / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D015721:Diphtheria-Tetanus-Pertussis Vaccine; D005938:Glucocorticoids; D017325:Hepatitis B Vaccines; D011244:Pregnadienediols; D011310:Preservatives, Pharmaceutical; D000068656:Mometasone Furoate; D013849:Thimerosal