In adults with a normal immune response, it is possible for vaccine derived or wild type rubella virus (RuV) to survive for years in small areas of uncharacteristic inflammation on the skin, according to research findings published in the Journal of the American Medical Association Dermatology.  

Rubella virus—vaccine derived and wild-type—has previously been identified in the skin inflammations of patients with inherited gene-mutation disorders that interfere with typical immune function. Researchers sought to investigate if an association exists between RuV and atypical granulomatous inflammation in otherwise healthy adults.

To accomplish this, they conducted a case series from January, 2019 to January 2021 that included 4 participants in 2 US dermatology clinics (3 women; mean 61.5 years of age, range 49.0-73.0 years) presenting with nodules, papules, and plaques only on their upper left arms that had been growing slowly for 4 to 19 years. Clinical examinations of the participants revealed no primary immune deficits. RuV was confirmed by the US Centers for Disease Control and Prevention (CDC) with staining, polymerase chain reaction, whole-genome sequencing, and cell culture.


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None of the participants reported other previous recurrent infections. Measles, mumps, and rubella (MMR) vaccine had been administered to 3 of the participants from 2 to more than 10 years before onset of upper arm skin inflammation. The fourth participant did not have the MMR vaccine. Chest radiography showed normal for all participants. Researchers noted that, “Phylogenetic analysis of the RuV sequences showed vaccine-derived RuV in 3 cases and wild-type RuV in 1.” Of the 2 participants in whom live rubella virus was recovered, 1 was immunocompetent, and researchers found it “surprising” and possibly historic that their virus could be cultured.

Researchers believed their only study limitation was the small number of participants from 2 clinics.

 “The case series study results suggest that RuV (vaccine derived and wild type) can persist for years in cutaneous granulomas in clinically immunocompetent adults and is associated with atypical (palisaded and necrotizing type) chronic cutaneous granulomas,” the researchers concluded. They encourage future retrospective cohort studies to include considerably more immune competent participants with idiopathic skin inflammation in order to investigate the role of vaccine-derived and wild-type RuV in their disease.

Disclosure: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Wanat KA, Perelygina L, Chen MH, et al. Association of persistent rubella virus with idiopathic skin granulomas in clinically immunocompetent adults. JAMA Dermatol. Published online March 26, 2022. doi:10.1001/jamadermatol.2022.0828