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A rare granulomatous reaction to Q fever vaccination following influenza vaccination

Deborah Burnett and Leslie Burnett
Med J Aust 2010; 193 (1): 60.
Published online: 5 July 2010

To the Editor: We report the case of a 19-year-old female veterinary student who presented with a 2-week history of a rapidly growing mass on the lateral side of the deltoid area of her left arm. On examination, the mass was soft, freely movable, slightly warm and non-tender. There was no regional lymphadenopathy. The patient was afebrile, with no signs of systemic illness. Ultrasound showed a 3.2 × 2.3 × 1 cm, low-echogenic, lobulated lesion in the subcutaneous fat, with surrounding increased echogenicity suggestive of inflammation. Magnetic resonance imaging showed a poorly defined lesion throughout the deep and superficial fascia, with infiltration into the underlying deltoid muscle (Box 1). A provisional diagnosis of sarcoma was made, but an ultrasound-guided core biopsy sample showed non-necrotising epithelioid granulomas (Box 2).

  • Deborah Burnett1,2
  • Leslie Burnett3,4

  • 1 Faculty of Veterinary Science, University of Sydney, Sydney, NSW.
  • 2 Walter and Eliza Hall Institute, Melbourne, VIC.
  • 3 Pathology North, PaLMS Pathology, Royal North Shore Hospital, Sydney, NSW.
  • 4 Sydney Medical School, University of Sydney, Sydney, NSW.


Acknowledgements: 

We thank Dr Alan Mills for his assistance in patient follow-up and Dr Fairweather and Dr Parker for their correspondence. We are grateful to Dr Andrew Stuart and Dr Sebastian Heinze of San Radiology, Sydney Adventist Hospital, and Dr Kirsty McIlroy and Dr Bernie Hudson of Pathology North, PaLMS Pathology, for the provision of medical records, diagnostic reports and images.

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