Lymphocytic vasculitis presenting as diffuse subcutaneous edema after hepatitis B virus vaccine.

We report a case of a previously healthy 26-year-old female who developed severe persistent swelling of the subcutaneous tissues after immunization with hepatitis B vaccine. Ultimately, the patient was found to have a lymphocytic vasculitis of the muscle, and the vasculitis responded completely to corticosteroids. Detailed immunopathologic analysis revealed the infiltrate to be composed of nonmonoclonal activated CD4-positive T cells.The case is instructive for the following reasons: a) Hepatitis B vaccine is now widely indicated. Although generally safe, it is associated with a variety of rheumatic conditions and may rarely trigger vasculitis. Immunization history is important in evaluating patients with rheumatologic symptoms. b) Diffuse subcutaneous edema/capillary leak is an unusual presentation of vasculitis and may be the result of interleukin 2 secretion by activated lymphocytes.