Abstract
AIMS: To alert pathologists to the spectrum of histological appearances that may be seen in injection site reactions related to aluminium. METHODS: Four cases of injection site reaction were examined microscopically using routine staining with haematoxylin and eosin, electron microscopy and by electron probe microanalysis. RESULTS: As in previous reports, all four cases included collections of histiocytes which contained faint granular brownish refractile material within their cytoplasm; ultrastructural examination showed this to be aluminium. Two cases showed a prominent inflammatory reaction with numerous lymphoid follicles and a notable eosinophilic infiltrate. Two cases showed unusual features not described previously. In one, there was a sclerosing lipogranuloma-like reaction with unlined cystic spaces containing crystalline material. The other case presented as a large symptomatic subcutaneous swelling which microscopically showed diffuse and wide-spread involvement of the subcutis by a lymphoid infiltrate with prominent lymphoid follicles. CONCLUSIONS: This report highlights the changes encountered in aluminium injection site reactions and emphasises that the lesions have a wider range of histological appearances than described previously.
Full text
PDF
Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Akosa A. B., Ali M. H., Khoo C. T., Evans D. M. Angiolymphoid hyperplasia with eosinophilia associated with tetanus toxoid vaccination. Histopathology. 1990 Jun;16(6):589–593. doi: 10.1111/j.1365-2559.1990.tb01164.x. [DOI] [PubMed] [Google Scholar]
- Clemmensen O., Knudsen H. E. Contact sensitivity to aluminium in a patient hyposensitized with aluminium precipitated grass pollen. Contact Dermatitis. 1980 Aug;6(5):305–308. doi: 10.1111/j.1600-0536.1980.tb04953.x. [DOI] [PubMed] [Google Scholar]
- Cox N. H., Moss C., Forsyth A. Allergy to non-toxoid constituents of vaccines and implications for patch testing. Contact Dermatitis. 1988 Mar;18(3):143–146. doi: 10.1111/j.1600-0536.1988.tb04500.x. [DOI] [PubMed] [Google Scholar]
- Fawcett H. A., Smith N. P. Injection-site granuloma due to aluminum. Arch Dermatol. 1984 Oct;120(10):1318–1322. [PubMed] [Google Scholar]
- Fischer T., Rystedt I. A case of contact sensitivity to aluminium. Contact Dermatitis. 1982 Sep;8(5):343–343. doi: 10.1111/j.1600-0536.1982.tb04247.x. [DOI] [PubMed] [Google Scholar]
- Johannessen H., Bergan-Skar B. Itching problems among potroom workers in factories using recycled alumina. Contact Dermatitis. 1980 Jan;6(1):42–43. doi: 10.1111/j.1600-0536.1980.tb03892.x. [DOI] [PubMed] [Google Scholar]
- Kaaber K., Nielsen A. O., Veien N. K. Vaccination granulomas and aluminium allergy: course and prognostic factors. Contact Dermatitis. 1992 May;26(5):304–306. doi: 10.1111/j.1600-0536.1992.tb00123.x. [DOI] [PubMed] [Google Scholar]
- Miliauskas J. R., Mukherjee T., Dixon B. Postimmunization (vaccination) injection-site reactions. A report of four cases and review of the literature. Am J Surg Pathol. 1993 May;17(5):516–524. [PubMed] [Google Scholar]
- ORELL S. R. Subcutaneous granulomata following inoculation of influenza vaccine. Acta Pathol Microbiol Scand. 1962;56:127–134. doi: 10.1111/j.1699-0463.1962.tb04174.x. [DOI] [PubMed] [Google Scholar]
- Pembroke A. C., Marten R. H. Unusual cutaneous reactions following diphtheria and tetanus immunization. Clin Exp Dermatol. 1979 Sep;4(3):345–348. doi: 10.1111/j.1365-2230.1979.tb02649.x. [DOI] [PubMed] [Google Scholar]
- Slater D. N., Underwood J. C., Durrant T. E., Gray T., Hopper I. P. Aluminium hydroxide granulomas: light and electron microscopic studies and X-ray microanalysis. Br J Dermatol. 1982 Jul;107(1):103–108. doi: 10.1111/j.1365-2133.1982.tb00297.x. [DOI] [PubMed] [Google Scholar]