Department of Infectious Diseases, İstanbul Training and Research Hospital, Istanbul, Turkey.
Infectious Diseases Unit, Sungurlu State Hospital, Çorum, Turkey.
BMC Infect Dis. 2021 Jan 12;21(1):53. doi: 10.1186/s12879-020-05756-3.
Vaccinations have been widely used worldwide since their invention to prevent various diseases, but they can also have some adverse effects ranging from mild local reactions to serious side effects. These adverse effects are generally self-limited and resolve within a short time without any treatment. While a sterile abscess following vaccination is a rare condition in adults, many cases have been reported regarding children in the literature. Here, we report a case of recurrent sterile abscesses, which occurred after a Td vaccination, treated with corticosteroids.
A 22-year old woman was admitted to our department with a complaint of swelling at the site of the vaccination. On physical examination, this mass was about 6 × 6 cm in size and fluctuating, but there were no pain complaints and no redness present. She had received her Td vaccination 3 weeks ago and the swelling had started at the site of the injection 4 days following this immunization. Oral amoxicillin/clavulanic acid and local antibiotic cream were administered for 10 days. The laboratory values were unremarkable. Despite the administration of antibiotics, the swelling did not regress, and on the contrary, continued to increase in size. On ultrasound, two interconnected abscesses were observed in the subcutaneous area, and did not involve the muscle tissue. Later, the abscesses were completely drained, and the samples were cultured. The current antibiotics were continued. The gram staining of the samples revealed abundant leukocytes but no microorganisms. The solid and liquid cultures of the materials remained negative. Despite the administration of multiple drainages and antibiotics, the mass recurred. Finally, the patient was considered to have a sterile abscess due to Td immunization. The antimicrobials were stopped. Local and oral corticosteroids were initiated. The swelling regressed significantly, and the treatments continued for 7 days. The patient has been doing well and has had no recurrence for over a year.
Corticosteroids appeared to improve the patient and therefore we suggest that the efficacy and route of administration of steroids in this situation should be explored further.
自发明以来，疫苗已在全球范围内广泛使用，以预防各种疾病，但它们也可能产生一些不良反应，从轻微的局部反应到严重的副作用不等。这些不良反应通常是自限性的，在没有任何治疗的情况下会在短时间内得到解决。虽然成人接种疫苗后无菌脓肿较为罕见，但文献中已有许多关于儿童的病例报告。在这里，我们报告了一例因 Td 疫苗接种后发生的复发性无菌脓肿病例，经皮质类固醇治疗后得到缓解。
一名 22 岁女性因接种部位肿胀到我院就诊。体格检查时，该肿块大小约为 6×6 厘米，有波动感，但无疼痛主诉，也无红肿。她在 3 周前接受了 Td 疫苗接种，在接种后 4 天，注射部位开始出现肿胀。她曾接受过 10 天的口服阿莫西林/克拉维酸和局部抗生素乳膏治疗。实验室检查结果无明显异常。尽管使用了抗生素，肿胀并未消退，反而继续增大。超声检查显示，皮下区域有两个相互连通的脓肿，未累及肌肉组织。后来，脓肿完全引流，标本进行了培养。继续使用当前抗生素。样本革兰氏染色显示大量白细胞，但无微生物。物质的固体和液体培养均为阴性。尽管多次引流和使用抗生素，肿块仍反复发作。最终，考虑患者为 Td 疫苗接种引起的无菌脓肿。停止使用抗生素。局部和口服皮质类固醇开始使用。肿胀明显消退，治疗持续了 7 天。患者情况良好，一年多来未再复发。
皮质类固醇似乎改善了患者的病情，因此我们建议进一步探索这种情况下类固醇的疗效和给药途径。
