case_images: PMC5959910_01
case_images: Strong local injection site reaction 4 days following PCV13 vaccination. a Circle indicates biopsy site, asterisk indicates the vaccine injection was done. b Skin biopsy shows infiltration of mononuclear cells, mostly consisting of CD4+ T cells and CD68+ macrophages, while B cells were virtually absent. Scale bar indicates 100 mum. c Serotype-specific IgG responses pre-vaccination (open bars) and 4 weeks post-vaccination (black bars) toward vaccine and non-vaccine strains. Values below lower detection limit (<0.3 mg/L) were set to 0.3 mg/L. d Pre-PCV vaccination titers against tetanus and diphtheria were low/undetectable. Post-PCV vaccination diphtheria titers (i.e., anti-carrier protein) were high
case_images: 41541_2018_59_Fig1_HTML.jpg
case_images: PMC5959910_01_41541_2018_59_Fig1_HTML.jpg
case_images: Fig1
case_images: PCV13 (Fig. 1). Prior to PCV vaccination she underwent a detailed immunological work-up at our immunodeficiency clinic because of recurrent lower respiratory tract infections. Three days later, she developed a progressive, extensive, and painful swelling and erythema of about 10 x 20 cm (4 x 8 inches), affecting almost all of her upper arm around the site of injection (Fig. 1a). CD68+ macrophages. This pathology is classical of a type IV delayed hypersensitivity reaction:as seen with a positive Mantoux tuberculosis skin test (Fig. 1b). CD8+ T cells were very sparse and B cells were almost completely absent (Fig. 1b). Pre-vaccine and 4 weeks post-vaccine anti-pneumococcal IgG levels were determined in a multiplexed serotype-specific assay testing a total of 14 serotypes: 7 that are included in PCV13, and 7 that are not (Fig. 1c). Strikingly, a very high pre-vaccination IgG titer was observed against the non-PCV13 serotype 8, suggesting prior infection with this serotype (Fig. 1c). There was a humoral response against the diphtheria carrier protein CRM197, as anti-diphtheria titers increased following PCV13 vaccination, which was not observed for an irrelevant control protein (tetanus) (Fig. 1d).