Aluminium‐induced granulomas after inaccurate intradermal hyposensitization injections of aluminium‐adsorbed depot preparations

Background: The development of persistent subcutaneous nodules at the injection sites of aluminium‐adsorbed hyposensitization solutions is rare. These nodules have been interpreted as a delayed, granulomatous hypersensitivity reaction to aluminium. We report for the first time a case of persistent intradermal granulomas that developed at the sites of inaccurate intradermal, instead of subcutaneous, hyposensitization injections. Methods: An intradermal nodule was excised and processed for histopathology, scanning electron microscopy, and X‐ray microanalysis. Intradermal and patch tests with aluminium hydroxide were performed. Results: Histologically, the nodule presented a pattern of granulomatous inflammatory reaction surrounding foci of necrotic tissue. Scanning electron microscopy and X‐ray microanalysis revealed deposits of aluminium within the granulomas. Patch tests with aluminium hydroxide were negative, and intradermal tests caused persistent intradermal granulomas. Subsequent hyposensitization therapy in our department with the usual subcutaneous injections of aluminium‐adsorbed allergen extracts was well tolerated by the patient. Conclusions: Local toxic effects of aluminium may be crucial in the development of persistent intradermal injection‐site granulomas. Such intradermal nodules may develop even if the subcutaneous route is well tolerated. We conclude that inaccurate intradermal injections of aluminium‐containing solutions have to be strictly avoided.