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Tipo:	Artigo de Periódico
Título:	Fatal viscerotropic and neurotropic disease after yellow fever vaccine: a rare manifestation leading to diagnosis of severe combined immunodeficiency in an infant
Autor(es):	Lara Jhullian Tolentinovieira Lilian Martins Oliveira Diniz Gabriela Assunção Goebel Yuri Barcelos Luciana Oliveira Cunha Luisa Teles Melo Santos Roberta Maia de Castro Romanelli Fernanda Gontijo Minafra Andrea Lucchesi de Carvalho Luiz Fernando Andrade de Carvalho
Resumo:	Yellow fever vaccine (YFV) is a live attenuated vaccine that can cause a mild infection in immunocompetent patients. However, it may not be self-limiting in patients with inborn errors of immunity (IEI) and may be the first and most severe presentation in these patients. A 10-month-old female infant sought emergency care presenting fever for three days and diffuse exanthema. She was a previous healthy child of consanguineous parents. The child had received YFV 28 days before the onset of symptoms. Upon hospital admission, petechial rash on the limbs and hepatosplenomegaly were noted on physical exam. Laboratory tests showed thrombocytopenia, increased serum aminotransferases and elevated gamma-glutamyl transferase (GGT) and alkaline phosphatase levels. During hospitalization she developed hypoactivity, drowsiness, and hypotonia. The possibility of viscerotropic and neurotropic vaccine associated disease was suspected and a possible primary immunodeficiency disease considered. The patient was tested for antibodies against the yellow fever virus (MAC ELISA) on serum and cerebrospinal fluid (CSF) samples, showing positive IgM results. Immunophenotyping showed low levels of lymphocytes and absence of T-cell receptor excision circles (TREC), leading to diagnose of severe combined immunodeficiency disease (SCID). Despite treatment, after 35 days of hospitalization, she evolved to cardiorespiratory arrest and death. Serious adverse events after administration of the YFV are rare and associated with neurological or visceral involvement in most cases. The unfavorable outcome highlights the importance of neonatal screening for SCID and the clinical suspicion of primary immunodeficiencies in infants who have serious adverse events to live virus vaccines.
Assunto:	Yellow Fever Vaccine
Idioma:	eng
País:	Brasil
Editor:	Universidade Federal de Minas Gerais
Sigla da Instituição:	UFMG
Departamento:	MED - DEPARTAMENTO DE PEDIATRIA
Tipo de Acesso:	Acesso Aberto
Identificador DOI:	https://doi.org/10.1590/S1678-9946202466050
URI:	http://hdl.handle.net/1843/83786
Data do documento:	2024
metadata.dc.url.externa:	https://www.scielo.br/j/rimtsp/a/hQhChbDC7sJPNvDMzqhxVZd/?lang=en
metadata.dc.relation.ispartof:	Revista do Instituto de Medicina Tropical de São Paulo
Aparece nas coleções:	Artigo de Periódico

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