Letters 4. Neven B, Pérot P, Bruneau J, et al. Cutaneous and visceral chronic Streptococcus pneumoniae, Haemophilus influenzae, and tetanus granulomatous disease triggered by a rubella virus vaccine strain in children toxoid despite the patient receiving these vaccines on schedule. with primary immunodeficiencies. Clin Infect Dis. 2017;64(1):83-86. doi:10. Isolatedcutaneousgranulomasmaybeapreviouslyunknownfea- 1093/cid/ciw675 ture of her particular NOD mutation variant, or perhaps further 5. Caso F, Galozzi P, Costa L, Sfriso P, Cantarini L, Punzi L. Autoinflammatory immunology evaluation may yield another explanation. granulomatous diseases: from Blau syndrome and early-onset sarcoidosis to NOD2-mediated disease and Crohn’s disease. RMD Open. 2015;1(1):e000097. doi:10.1136/rmdopen-2015-000097 Discussion | These 2 cases add to the growing number of reports 6. Lo Schiavo A, Ruocco E, Russo T, Brancaccio G. Locus minoris resistentiae: regarding VDRV in association with granulomas in patients with An old but still valid way of thinking in medicine. Clin Dermatol. 2014;32(5): immunesystemdefects.ThefindingofVDRVingranulomasraises 553-556. doi:10.1016/j.clindermatol.2014.04.001 the question of whether rubella vaccine is an antigenic trigger or a bystander. The cases described in the literature report the lo- calizationofVDRVinaffectedskin,itsabsenceinnormalskin,and COMMENT & RESPONSE itsabilitytopersistinanti-inflammatoryM2macrophages,aswell as keratinocytes, while accumulating mutations. All reports sug- The Role of Microcirculatory Dysfunction gestacausalrelationshipbetween rubella viruspersistence inthe in the Pathophysiology and Treatment 1-4 skinandgranulomadevelopment.
JAMA Dermatology – American Medical Association
Published: Jul 15, 2019