Case Report: Rubella Virus-Induced Cutaneous Granulomas in Two Pediatric Patients With DNA Double Strand Breakage Repair Disorders – Outcome After Hematopoietic Stem Cell Transplantation
Ulrich Baumann, Johannes H. Schulte, J. Gross, Rita Beier, Marius Ludwig, V. Wahn, Jörg Hofmann, Britta Maecker‐Kolhoff, Martin G. Sauer, Petra Kaiser‐Labusch, Negin Karimian, Ulrike Blume‐Peytavi, Franziska C. Ghoreschi, Hagen Ott, Ludmila Perelygina, Christian Klemann, Oliver Blankenstein, Horst von Bernuth, Renate Krüger
Abstract
We report two patients with DNA repair disorders (Artemis deficiency, Ataxia telangiectasia) with destructive skin granulomas, presumably triggered by live-attenuated rubella vaccinations. Both patients showed reduced naïve T cells. Rapid resolution of skin lesions was observed following hematopoietic stem cell transplantation. However, the patient with AT died due to complications of severe hepatic veno-occlusive disease 6 month after HSCT. Dried blood spots obtained after birth were available from this patient and showed absent T-cell receptor excision circles (TRECs). Therefore, newborn screening may help to prevent patients with moderate T-cell deficiency from receiving live-attenuated rubella vaccine potentially causing granulomas.