Fundação Hospitalar do Estado de Minas Gerais, Hospital Infantil João Paulo II, Programa de Residência Médica em Pediatria, Belo Horizonte, Minas Gerais, Brazil.
Universidade Federal de Minas Gerais, Departamento de Pediatria, Belo Horizonte, Minas Gerais, Brazil.
Rev Inst Med Trop Sao Paulo. 2024 Aug 26;66:e50. doi: 10.1590/S1678-9946202466050. eCollection 2024.
Yellow fever vaccine (YFV) is a live attenuated vaccine that can cause a mild infection in immunocompetent patients. However, it may not be self-limiting in patients with inborn errors of immunity (IEI) and may be the first and most severe presentation in these patients. A 10-month-old female infant sought emergency care presenting fever for three days and diffuse exanthema. She was a previous healthy child of consanguineous parents. The child had received YFV 28 days before the onset of symptoms. Upon hospital admission, petechial rash on the limbs and hepatosplenomegaly were noted on physical exam. Laboratory tests showed thrombocytopenia, increased serum aminotransferases and elevated gamma-glutamyl transferase (GGT) and alkaline phosphatase levels. During hospitalization she developed hypoactivity, drowsiness, and hypotonia. The possibility of viscerotropic and neurotropic vaccine associated disease was suspected and a possible primary immunodeficiency disease considered. The patient was tested for antibodies against the yellow fever virus (MAC ELISA) on serum and cerebrospinal fluid (CSF) samples, showing positive IgM results. Immunophenotyping showed low levels of lymphocytes and absence of T-cell receptor excision circles (TREC), leading to diagnose of severe combined immunodeficiency disease (SCID). Despite treatment, after 35 days of hospitalization, she evolved to cardiorespiratory arrest and death. Serious adverse events after administration of the YFV are rare and associated with neurological or visceral involvement in most cases. The unfavorable outcome highlights the importance of neonatal screening for SCID and the clinical suspicion of primary immunodeficiencies in infants who have serious adverse events to live virus vaccines.
黄热病疫苗（YFV）是一种减毒活疫苗，可在免疫功能正常的患者中引起轻度感染。然而，在先天性免疫缺陷（IEI）患者中，它可能无法自行限制，并且可能是这些患者的首次也是最严重的表现。一名 10 个月大的女婴因发热三天和全身皮疹前来急诊。她是一对近亲所生的健康儿童。孩子在出现症状前 28 天接种了 YFV。入院时，体格检查发现四肢有瘀点样皮疹和肝脾肿大。实验室检查显示血小板减少、血清转氨酶升高以及γ-谷氨酰转移酶（GGT）和碱性磷酸酶水平升高。住院期间，她出现活动减少、嗜睡和肌张力减退。怀疑存在内脏亲和性和神经亲和性疫苗相关疾病，并考虑可能存在原发性免疫缺陷疾病。对患者的血清和脑脊液（CSF）样本进行了黄热病病毒抗体检测（MAC ELISA），结果显示 IgM 阳性。免疫表型显示淋巴细胞水平低，缺乏 T 细胞受体切除环（TREC），导致严重联合免疫缺陷病（SCID）的诊断。尽管进行了治疗，但在住院 35 天后，她还是发展为心肺骤停并死亡。YFV 给药后发生严重不良事件较为罕见，且大多数情况下与神经系统或内脏受累有关。不良结局突显了对 SCID 进行新生儿筛查以及对发生严重不良事件的活病毒疫苗婴儿进行原发性免疫缺陷临床怀疑的重要性。
