28697 Generalized granuloma annulare-like eruption induced by recombinant varicella zoster virus vaccination

Abstract

A 52-year-old Caucasian female presented to the clinic with a 10-day history of a red pruritic rash distributed on the arms and hands. History revealed that the patient had received a recombinant varicella zoster vaccination six weeks prior to the skin eruption. Physical exam revealed bright red to violaceous indurated papules and annular plaques distributed to the bilateral upper arms, palmar hands, and ventral wrists. Punch biopsy performed on the right superior posterior arm demonstrated granulomatous inflammation characterized by palisaded histiocytes and mucin deposition. No eosinophils or plasma cells were present. No evidence of viral cytological atypia or infectious organisms were identified. The patient failed treatment with four weeks of oral prednisone and topical clobetasol 0.05% ointment. Treatment with hydroxychloroquine 200 mg twice-per-day for four weeks, then 200 mg per day for four weeks resolved the condition. Six weeks after the second dose of recombinant varicella zoster vaccination, the granuloma annulare-like eruption reappeared in the areas previously affected. Therapy with hydroxychloroquine was repeated in the same manner with complete clearance of skin lesions. We present this case as a unique presentation of granuloma annulare-like eruption developing as a recall reaction to recombinant varicella zoster vaccination.