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KMID : 0363220160540060501
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Korean Journal of Dermatology
2016 Volume.54 No. 6 p.501 ~ p.502
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A Case of Pilomatricoma Arising at a Diphtheria-tetanus-pertussis Vaccination Site
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Jeong Do-Seon
Moon Yun-Sun
Jeong Hae-Bong
Kim Chi-Yeon
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Abstract
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Pilomatricoma is the most common hair-follicle tumor and typically occurs on the head, neck, or upper limb. The etiology of pilomatricoma is subject to controversy. Trauma, insect bites, and surgery are thought to be antecedent events to the onset of the tumors. We describe a case of pilomatricoma arising at a diphtheria-tetanus-pertussis (DTP) vaccination site. To our knowledge, pilomatricoma is rarely associated with vaccination1,2 and extremely rarely associated with DTP vaccination3. A 4-year-old girl received a DTP vaccination in the left upper arm. Two months later, she visited our dermatology outpatient department with a 0.5×0.4 cm deep-seated tender nodule on her left arm at the site of administration of the DTP vaccine (Fig. 1). There was no local lymphadenopathy, and the patient was otherwise well. An excisional biopsy was performed and showed a dermal tumor located in the lower dermis. The tumor comprised two types of cells, basophilic cells and shadow cells (Fig. 2). The specimen was identified as pilomatricoma. There was no local recurrence at the patient’s follow-up visit 5 months later. Local complications of intramuscular injection include pain, abscess, bleeding, thrombosis, necrosis, ulceration, gas gangrene, nerve injuries, subcutaneous atrophy, fibrosis and contracture of muscles and joints, and granulomas4. Tumors at the site of intramuscular injection are extremely unusual4. The etiology of pilomatricoma is not clear but thought to be due to the pause in the life cycle of hair follicles caused by trauma and inflammation5. A needlestick injury or similar trauma damaging the follicular epithelium at the injection site may lead to a faulty suppression of apoptosis, which in turn may result in the formation of pilomatricoma1. The pathogenesis of pilomatricoma following vaccination injection is intriguing. Although the exact pathogenesis in our case remains unexplored, the history supports an association with the DTP vaccine or intramuscular injection. We suggest that pilomatricoma be included in the differential diagnoses of tumors arising at DTP vaccination sites.
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KEYWORD
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DTP, Pilomatricoma, Vaccination
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