title: Pneumococcal 13-Valent Conjugate Vaccine (Prevnar 13)-Associated Immune Thrombocytopenic Purpura in a Renal Transplant Recipient: A Case Report.
abstract: BACKGROUND
  Pneumococcal 13-valent conjugate vaccine (PCV13) is used for immunization to prevent invasive disease caused by Streptococcus pneumoniae. Rare cases of idiopathic thrombocytopenic purpura (ITP) after vaccination with PCV13 have been reported.
  
  
  METHODS
  A case of ITP associated with PCV13 administration in a renal allograft recipient is described. A 77-year-old man presented with bruising at insulin injection sites for 1 week. He had end-stage renal disease and received a kidney transplant 22 months previously. Maintenance immunosuppression included tacrolimus and prednisone.
  
  
  RESULTS
  Physical examination showed normal vital signs and petechial rash in the areas of insulin injections. Laboratory testing resulted in hemoglobin, 11.7 g/dL; white blood cell count, 7700/mm(3); and platelet count, 3000/mm(3) (baseline, 140,000). Workup for infection, hemolysis, and thrombotic thrombocytopenic purpura was negative. Isolated thrombocytopenia was diagnosed as ITP and was attributed to PCV13 vaccination that he had received 1 month ago. He was treated with methylprednisolone, pooled immunoglobulins, and platelet transfusions. Subsequent platelet counts improved to his baseline of 140,000 over a period of 3 weeks. The PCV13 works by generating a T-helper-cell response.
  
  
  CONCLUSIONS
  ITP may involve antibody production driven by T-helper cells reacting to platelet surface glycoproteins. This case is unique in that it occurred in a patient who was on immunosuppression with a calcineurin inhibitor and corticosteroids.
authors.affiliation: Department of Nephrology, Washington University, Saint Louis, Missouri, USA. Electronic address: sgupta@dom.wustl.edu.
authors.forename: S
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Department of Nephrology, Washington University, Saint Louis, Missouri, USA.
authors.forename: D C
authors.initials: DC
authors.lastname: Brennan
mesh_terms: D000368:Aged; D000069443:Heptavalent Pneumococcal Conjugate Vaccine / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D010976:Platelet Count; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood / Q000209:etiology*; D016559:Tacrolimus / Q000627:therapeutic use; D014611:Vaccination / Q000009:adverse effects*
chemical_list: D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D007166:Immunosuppressive Agents; D016559:Tacrolimus