Granulomatous disease prompts a search for antigenic triggers, given our understanding of granuloma formation as a defense mechanism against persistent antigen in tissue. Cutaneous granulomas in patients with primary immunodeficiency have been attributed to immune dysregulation because no infectious trigger has been identified in these patients.1 However, recent reports have emerged of skin biopsies in at least 9 children with primary immunodeficiency confirming the presence of vaccine-derived rubella virus (VDRV) related to the RA27/3 vaccine strain in granulomas and its absence in normal skin.2-4 Immune deficiency may allow for the persistence of vaccine-strain virus, which could accrue mutations.3 We report herein the cases of 2 children with cutaneous granulomas harboring VDRV, one with primary immunodeficiency, and the other with undefined immunodeficiency.
Dhossche J, Johnson L, White K, et al. Cutaneous Granulomatous Disease With Presence of Rubella Virus in Lesions. JAMA Dermatol. Published online June 05, 2019. doi:10.1001/jamadermatol.2019.0814
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