title: A 4-month-old baby presenting with dermal necrotizing granulomatous giant cell reaction at the injection site of 13-valent pneumococcal conjugate vaccine: a case report.
abstract: BACKGROUND
  Adjuvants (for example, aluminum salts) are frequently incorporated in licensed vaccines to enhance the host immune response. Such vaccines include the pneumococcal conjugate, combinations of diphtheria-tetanus/acellular pertussis, tetanus- diphtheria/acellular pertussis, hepatitis B, some Haemophilus influenzae type b, hepatitis A, and human papillomavirus. These preparations have been associated with complicated local adverse events, especially if administered subcutaneously or intradermally in comparison to deep intramuscular injection. We describe a severe inflammatory reaction at the site of an injection of 13-valent pneumococcal conjugate vaccine.
  
  
  METHODS
  A 4-month-old Arab baby boy developed dermal necrotizing granulomatous giant cell reaction at the injection site (right anterior thigh) of the second dose of 13-valent pneumococcal conjugate vaccine. Ziehl-Neelsen and periodic-acid Schiff were negative. This reaction probably resulted from improper intramuscular administration because the first (at 2 months of age) and third (at 10 months of age) doses were uneventful.
  
  
  CONCLUSIONS
  Dermal necrotizing granulomatous reactions are a serious complication of the 13-valent pneumococcal conjugate vaccine. Health care providers need to administer this preparation deeply into a muscle mass. Completing the vaccine series is an acceptable option. Physicians are encouraged to report their experience with completing vaccine series following adverse events.
authors.affiliation: Department of Pediatrics, United Arab Emirates University, P,O, Box 17666, Al-Ain, UAE. alsuwaidia@uaeu.ac.ae.
authors.forename: Ahmed R
authors.initials: AR
authors.lastname: Alsuwaidi
authors.forename: Alia
authors.initials: A
authors.lastname: Albawardi
authors.forename: Navidul Haq
authors.initials: NH
authors.lastname: Khan
authors.forename: Abdul-Kader
authors.initials: AK
authors.lastname: Souid
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001706:Biopsy; D020682:Cefixime / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004891:Erythema Induratum / Q000139:chemically induced* / Q000150:complications; D015726:Giant Cells / Q000187:drug effects* / Q000473:pathology; D006099:Granuloma / Q000139:chemically induced* / Q000150:complications / Q000473:pathology; D006801:Humans; D007223:Infant; D007249:Inflammation / Q000139:chemically induced / Q000150:complications / Q000473:pathology; D007710:Klebsiella Infections / Q000150:complications / Q000188:drug therapy; D008297:Male; D009336:Necrosis / Q000139:chemically induced / Q000150:complications; D022242:Pneumococcal Vaccines / Q000009:adverse effects*; D013848:Thigh / Q000473:pathology; D014611:Vaccination / Q000009:adverse effects*; D018074:Vaccines, Conjugate / Q000009:adverse effects
chemical_list: C538862:13-valent pneumococcal vaccine; D000900:Anti-Bacterial Agents; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate; D020682:Cefixime