Pulmonary and cutaneous vasculitis following hepatitis B vaccination.

The case history is presented of a previously healthy non-atopic woman who developed cutaneous vasculitis, confirmed by biopsy, and pulmonary problems after inoculatiorn with recombinant hepatitis B vaccine. (Thorax 1993;48:580-581) Vaccination with hepatitis B recombinant vaccine is highly effective in producing immunity in immunocompetent patients. It has few side effects, usually consisting of early local reactions to the thimerosal or aluminium components of the vaccine.'-3 We report a case of cutaneous vasculitis, confirmed by biopsy, who also had pulmonary problems after the first inoculation with recombinant hepatitis B vaccine. %.:b~~~~~~~~~~~~~. .| S Figure 1 Chest radiograph on admission. Investigations showed no microscopic haematuria; urea concentration, liver function test results, plasma viscosity, and full blood count were normal, with no eosinophilia present. The chest radiograph showed bilateral basal mottling (fig 1), and results of pulmonary function tests revealed a restrictive pattern (FEV,/FVC ratio 80%) with small lung volumes and a gas transfer corrected for lung volume (Kco) of 69% predicted. St James's University Hospital, Beckett Street, Leeds LS9 7TF M B Allen P Cockwell R L Page Reprint requests to: Dr M B Allen, Leeds Chest Clinic, 74 New Briggate, Leeds LS1 6PH Received 17 June 1992 Retumed to authors 29 July 1992 Revised version received 10 August 1992 Accepted 14 August 1992 Case report A previously healthy 45 year old non-atopic woman taking no regular medication received her first dose of recombinant hepatitis B vaccine (20 ug in 1 ml, Engerix B; Smith, Kline and Beecham). Two days later she developed a pruritic rash on both feet which spread to her trunk and face. Over the next few days she developed breathlessness on minimal exertion, severe malaise, Raynaud's phenomenon, and a symmetrical polyarthralgia affecting her hands, wrists, elbows, and feet. In view of her multiple problems, admission to hospital was arranged. On examination she was ill with a maculopapular rash over most of her body. Mobility of her hands was reduced because of arthralgia but no arthritis was evident. Nail bed infarcts were present along with necrosis of the distal finger pulps, in keeping with a digital vasculitis. Auscultation of her chest revealed fine inspiratory crackles at both bases. No abnormality was found in her eyes. Figure 2 Photomicrograph ofskin biopsy specimen showing perivascular infiltrate in keeping with vasculitis. 580 group.bmj.com on April 12, 2017 Published by http://thorax.bmj.com/ Downloaded from