Vaccinazione contro l'epatite B e lichen ruber planus

HBV vaccination is considered one of the safest and side effects are rare. Two cases of lichen planus following an anti-hepatitis B vaccination have already been observed. We report another case. The aim of this report is to gain a better insight into the correlation between the 2 events. Therefore it is very important to refer every new observation. Case report: We report the case of a 34-year-old woman who received HBV vaccine Engerix-B (SKandF), a non-infectant viral subunity vaccine obtained from the cell recombinant leaven. She developed a lichen planus about 15 days after the administration of the second dose. All her routine laboratory test results were normal: HBsAg, HBeAg, HBcAg and HBcAb were negative, while HBsAb resulted positive. The patient received a systemic treatment of Deflazacort. Discussion: There are several reports of the association of lichen planus with liver diseases, in particular with chronic active hepatitis and primary biliary cirrhosis. The role played by the HBV infection has not yet been explained, nevertheless a high percentage of patients affected by lichen planus and chronic liver diseases produces antibodies against this virus. Recently 2 cases of lichen planus following an anti-hepatitis B vaccination were observed and they also suggest some correlation between the presence of the antibodies against hepatitis virus and the appearance of lichen planus. In the present case the absence of other possible factors considered responsible for lichen planus, the antibody movement against B hepatitis virus induced by vaccination, and the description of 2 analogous cases in literature suggest the possible correlation between the anti-hepatitis B vaccination and the lichen planus appearance. It is possible that the process is due to an immunologic mechanism. A sensitization following vaccination may be produced by one of the viral proteins and may induce modified keratinocyte surface antigens. Lichen planus may be determined by T-lymphocyte cytotoxic activity against keratinocytes. Conclusions: Perhaps the occurrence of lichen planus may not only be a coincidental event, but rather the direct consequence of a previous vaccination. Therefore this report suggests another possible cause of lichen planus.