Granuloma and persistent detection of wild-type rubella virus in an immunocompromised patient

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We report a case of wild-type rubella virus (genotype 2B) granuloma in a 29-year-old immunocompromised patient with a full vaccination scheme. He had been followed since his early teens for an unlabeled systemic inflammatory disease. On an inguinal node biopsy, histological analysis revealed a nguudiffuse non-necrotic granulomatous inflammation with no identified conventional infectious agent involved in granuloma formation. Further virological investigation revealed rubella virus (RuV) RNA detected by reverse transcription polymerase chain reaction (RT-PCR). Wild-type viral RNA persistence was documented in plasma samples collected up to 25 months after initial detection and also in different sequential biological samples (cerebrospinal fluid and nasopharyngeal swab). In the context of incomplete rubella eradication, RuV must be added to the list of potential triggers of chronic granuloma in immunodeficient patients.IMPORTANCERubella has become rare but has not yet disappeared. Rubella virus (RuV) must be added to the list of potential triggers of granuloma, particularly in immunodeficient patients. Diagnosis of RuV granulomas requires molecular testing of biopsy. RuV sequencing distinguishes between wild-type and vaccine-derived viruses and enables epidemiological surveillance.

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