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Pneumococcal vaccine and hepatic injury

Question:

8/30/2018
A patient developed large local red hot swelling at site of Pneumovax a few hours after the injection. Also had fever and malaise and was admitted to hospital for four days with low WBC and high liver enzymes. No rash elsewhere nor any respiratory issues. Took 2 months to fully recover. Pt has no spleen. Symptoms not typical of immediate anaphylactic reaction or delayed reactions. What's the best next course of action? No history of adverse reaction to any vaccine.

Answer:

A search of pubmed (pneumovax and hepatic injury or increased LFTs) did not produce any articles. In the body of your question, there was no mention as to the work up that occurred, so I will assume that there we no infectious, auto immune, malignancy or other pathology that could account for the acute hepatitis the patient had.

In terms of the pneumovax and was the patient immunized from the vaccine, my first step would be to check pneumococcal titers and if these are positive then the patient was successfully vaccinated. I would recommend reaching out to the vaccine manufacturer and query them if they have any reports in their data base about this type of reaction to pneumovax.

I hope this has been helpful

Andrew Murphy, MD, FAAAAI