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Rheumatology 2001; 40: 345-346
© 2001 British Society for Rheumatology
Letters to the Editor |
Henoch–Schönlein purpura following meningitis C vaccination
Department of Rheumatology, Craigavon Area Hospital, Lurgan Road, Portadown, Craigavon, Belfast BT63 5QQ, UK
SIR, A meningitis C vaccination programme has recently been introduced into the UK [1]. We report a case of vasculitis occurring 7days after vaccination in a 17-yr-old female.
The patient presented with a palpable purpuric rash in an extensor distribution affecting the back, buttocks, arms and legs. The rash subsequently became more extensive and bullous in character. There was synovial swelling at the right wrist and elbow. The ankles were painful but not swollen. On the day following admission she became systemically unwell with pyrexia of 37.8°C, and she developed severe abdominal pain. There was a sinus tachycardia of 120 beats per minute but blood pressure was normal (130/75 mmHg). There was tenderness in the left hypochondrium but no bowel upset or gastrointestinal bleeding.
Investigations showed ++ protein and ++ blood on dipstick urinalysis. Urine microscopy revealed 80 red cells per high-power field but no casts. Inflammatory markers were elevated, with an erythrocyte sedimentation rate of 73 mm/h and C-reactive protein of 292 mg/ml. Blood cultures were negative. Urea and electrolytes were normal and a 24-h urine sample showed a normal creatinine clearance of 102 ml/min with elevated protein excretion of 0.49 g/24 h. Serum immunoglobulins showed elevated IgA of 4.3 g/l (normal range 0.5–3.0) and other immunoglobulin subsets were normal. The following investigations were normal or negative: antinuclear antibody, antineutrophil cytoplasmic antibodies (ANCA), cryoglobulins, complement and immune complexes. Skin biopsy showed a leukocytoclastic vasculitis and an ultrasound scan of the kidneys was normal.
A clinical diagnosis of Henoch–Schönlein purpura (HSP) was made and treatment with prednisolone 20 mg was commenced on the third day after admission. There was a marked improvement of the vasculitic rash, arthritis and abdominal pain within 24 h. The patient was well enough for discharge 9 days later and the prednisolone was withdrawn after a further 2 weeks.
The onset at the age of 17 yr and the presence of acute abdominal pain, palpable purpura and leukocytoclastic vasculitic rash fulfil ACR criteria for HSP [2]. In addition, the features of arthritis, proteinuria, haematuria and elevated serum IgA are typical of HSP. The onset of this illness 1 week after meningitis C vaccination may implicate the vaccine as a possible trigger. The other explanation is that the timing of the vaccination before the onset of vasculitis was coincidental.
The association between vaccination and the onset of vasculitis including HSP has been reported before [3–5]. HSP has been observed following influenza vaccination [3] and measles vaccination [4]. Progression of renal disease following influenza vaccination has also been reported in a patient with HSP [6]. Leukocytoclastic vasculitis after pneumococcal vaccination was reported by Fox and Petersen [7], and vasculitis has also been reported after hepatitis B and BCG vaccinations [5, 8].
The meningitis C vaccine (Meningitec) has been tested on 20 000 individuals in the USA. It is not a live vaccine and only local irritation had been reported [1]. The meningococcal surface polysaccharide is conjugated with a protein and provides long-term protection. There has been a relative increase in group C infection [9], which now accounts for 40% of all meningococcal infections and 150 out of 260 deaths per year. The vaccine is targeted at babies, children receiving MMR (mumps, measles and rubella) vaccination in the second year of life, and teenagers (15–17 yr old).
The administration of meningitis C vaccination 1 week before the onset of HSP suggests that it can be added to the list of potential triggering agents.
Notes
Correspondence to: P. A. Courtney. 
References
- Wise J. UK introduces new meningitis C vaccine. Br Med J1999;319:278.
[Free Full Text] - Mills JA, Michel BA, Bloch DA et al. The American College of Rheumatology 1990 criteria for the classification of Henoch–Schönlein purpura. Arthritis Rheum1990;33:1114–21.[ISI][Medline]
- Patel U, Bradley JR, Hamilton DV. Henoch–Schonlein purpura after influenza vaccination. Br Med J Clin Res Ed1988;296:1800.
- Mastroiacovo P. Measles vaccination and Schonlein–Henoch purpura. Minerva Pediatr1976;28:1591.[ISI][Medline]
- Le Hello C, Cohen P, Bousser MG, Letellier P, Guillevin L. Suspected hepatitis B vaccination related vasculitis. J Rheumatol1999;26:191–4.[ISI][Medline]
- Damjanov J, Amato JA. Progression of renal disease in Henoch–Schonlein purpura after influenza vaccination. J Am Med Assoc1979;242:2555–6.[Medline]
- Fox BC, Peterson A. Leukocytoclastic vasculitis after pneumococcal vaccination. Am J Infect Control1998;26:365–6.[ISI][Medline]
- Watson DA. Pustular vaccination complicating BCG vaccination. Tuber Lung Dis1992;73:126.[ISI][Medline]
- Fogarty J, Keane CT, Carroll R, Byrne M, Moloney AC. Meningococcal disease in childhood—a regional study in Ireland. J Infect1994;28:199–207.[Medline]
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