Granulomas associated with tetanus toxoid immunization.

Two patients developed localized nodular reactions at the site of prior tetanus toxoid injections. Histology of the lesions showed granuloma formation with central granular debris surrounded by a histiocytic mantle. Peripheral to this was a dense lymphoid infiltrate with eosinophils. Examination with energy dispersive x-ray microanalysis confirmed the presence of aluminium and phosphorus in the granular debris but not in the surrounding infiltrate.