Extensive Limb Swelling after Vaccination

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Vaccination is one of the most successful public health issues in the history of medicine. Although rare, complications after vaccination occur. The knowledge of possible side effects is crucial to allow prompt diagnosis and treatment, as well as education of parents, who are often insecure in their attitude toward vaccination programs.

A healthy 20-month-old boy was brought to the emergency department because of extensive swelling of his right thigh. Two days earlier, he had received his routine vaccination with a fourth dose of a diphtheria-tetanus-acellular pertussis–inactivated polio–Haemophilus influenzae type b–hepatitis B vaccine in his right thigh and a second dose of a measles-mumps-rubella vaccine in his left thigh. In association with a short episode of fever, swelling began 24 hours after vaccination around the injection site and increased over the next day. No impairment of his general condition or motor activity occurred. The patient’s medical history was uneventful, and there were especially no allergies and no adverse reactions after prior vaccinations.

On presentation, the entire thigh was red, warm, and tense but not painful (Figure). Active and passive movements of the limbs were normal. Despite the impressive finding, the boy seemed well, running and playing actively during the examination. Complete spontaneous recovery was observed over the next days without sequelae.

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• Figure. 

  Extensive swelling of the entire right thigh after DTaP-IPV-Hib-HepB booster vaccination.

Extensive limb swelling is known after booster doses of diphtheria–tetanus–acellular pertussis vaccines and occurs in 2% of children after the fourth diphtheria–tetanus–acellular pertussis vaccine dose.¹ It is not associated with complications after further booster vaccinations, and the immunization schedule should be continued as recommended.

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Reference 

1. Rennels MB, Deloria MA, Pichichero ME, Losonsky GA, Englund JA, Meade BD, et al. Extensive swelling after booster doses of acellular pertussis-tetanus-diphtheria vaccines. Pediatrics. 2000;105:e12
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