Track: Case Reports

Abstract:

Vaccination-induced guttate psoriasis is rare, with only a few cases reported and most associated with COVID-19 vaccinations. A healthy 6-year-old male developed de novo guttate psoriasis following DTaP, Hep B, MMRV, and Polio vaccinations as part of his routine immunization schedule. Two days after his vaccinations, he developed interdigital erythematous papules on bilateral hands, spreading to his face, torso, and lower extremities. Ill-circumscribed hyperpigmented macules and patches were appreciated. Antecedent streptococcal infections, accompanying symptoms, or any new exposures were not endorsed. The rash was presumed to be a scabies infection, however the lesions remained recalcitrant to usual therapies. The lesions became superinfected, and the patient was admitted for antibiotic therapy; bacterial tissue cultures grew Group A streptococcus. A punch biopsy revealed regular psoriasiform acanthosis, hypogranulosis, mild spongiosis, and intracorneal neutrophilic foci. Given the clinical picture, the diagnosis was compatible with guttate psoriasis, and the rash ultimately resolved with antibiotics and topical betamethasone. Herein, we report a rare case of pediatric guttate psoriasis following administration of the DTaP, Hepatitis B, MMRV, and Polio vaccines. The initial clinical presentation closely resembled scabies, highlighting the importance of diagnostic scrutiny in cases of a persistent rash. Awareness that guttate psoriasis can manifest after routine childhood immunizations may aid physicians in earlier diagnosis and appropriate management of pediatric eruptions with similar presentations. When the presentation is atypical or unresponsive to standard treatments, further workup, including skin biopsy, may be warranted.

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Lynn Guo