title: Systemic inflammatory reaction after pneumococcal vaccine: a case series.
abstract: BACKGROUND
  Fever, leukocytosis, and large local reactions following the pneumococcal polysaccharide vaccine (PS23) have been described only in isolated case reports in the adult literature. Such atypical reactions can pose difficulty to providers when determining management. Patients experiencing this noninfectious reaction may receive unnecessary treatment if the diagnosis of robust inflammatory response to the PS23 vaccine is not considered.
  
  
  METHODS
  This is a clinical case series of 5 adult patients who received the influenza and PS23 vaccines and experienced a cellulitis-like reaction, fever, and leukocytosis in the days following vaccination. Four of the five patients received the influenza and PS23 vaccines in the same arm. The patient who received the vaccines in opposite arms had the local findings in the arm that received the PS23 vaccine. All 5 patients sought care and 4 were admitted to the hospital for observation or treatment with intravenous antibiotics.
  
  
  CONCLUSIONS
  This case series highlights potential side effects of the PS23 vaccine that are not well described in the adult literature. Antibiotics were not helpful in treating these patients' local and systemic symptoms. Patients with histories consistent with that highlighted in this case series may avoid antibiotics and hospitalization if their providers recognize these symptoms as a noninfectious reaction to the PS23 vaccine.
authors.affiliation: Division of Allergy/Immunology/Immunizations; Walter Reed National Military Medical Center; Bethesda, MD USA.
authors.forename: Kelley A
authors.initials: KA
authors.lastname: von Elten
authors.affiliation: Vaccine Healthcare Centers Network; Walter Reed National Military Medical Center; Bethesda, MD USA.
authors.forename: Laurie L
authors.initials: LL
authors.lastname: Duran
authors.affiliation: Division of Allergy/Immunology/Immunizations; Walter Reed National Military Medical Center; Bethesda, MD USA.
authors.forename: Taylor A
authors.initials: TA
authors.lastname: Banks
authors.affiliation: Division of Allergy/Immunology/Immunizations; Walter Reed National Military Medical Center; Bethesda, MD USA.
authors.forename: Taylor A
authors.initials: TA
authors.lastname: Banks
authors.affiliation: Vaccine Healthcare Centers Network; Walter Reed National Military Medical Center; Bethesda, MD USA.
authors.forename: Limone C
authors.initials: LC
authors.lastname: Collins
authors.affiliation: Vaccine Healthcare Centers Network; Walter Reed National Military Medical Center; Bethesda, MD USA.
authors.forename: Limone C
authors.initials: LC
authors.lastname: Collins
mesh_terms: D000328:Adult; D002481:Cellulitis / Q000209:etiology / Q000473:pathology; D005260:Female; D005334:Fever / Q000209:etiology / Q000473:pathology; D006801:Humans; D007964:Leukocytosis / Q000209:etiology / Q000473:pathology; D008297:Male; D022242:Pneumococcal Vaccines / Q000008:administration & dosage* / Q000009:adverse effects*; D018746:Systemic Inflammatory Response Syndrome / Q000139:chemically induced* / Q000473:pathology; D055815:Young Adult
chemical_list: C414006:23-valent pneumococcal capsular polysaccharide vaccine; D022242:Pneumococcal Vaccines
keywords: local vaccine reaction; pneumococcal polysaccharide vaccine; systemic inflammatory vaccine reaction