Probable Transient Anterior Bulging Fontanelle after Measles Vaccination


Probable Transient Anterior Bulging Fontanelle after Measles Vaccination: A Case in Arba Minch General Hospital, Southwestern Ethiopia


Silabat Aschalew1, Sisay Legesse2, Abate Waldetensai3

1South Omo Zonal Health Department, Southwestern Ethiopia
2Arba Minch University Department of Public Health, Southwestern Ethiopia
3Ethiopian Public health institute, Addis Ababa, Central Ethiopia


International-Journal-of-Case-Reports-2d code

Transient anterior bulging fontanelle is a rare but serious medical condition, which can be classified as definite and probable transient bulging fontanelle. Conducting case surveillance, diagnosis and on time reporting during vaccination is of paramount importance in managing the adverse events following immunization. We diagnosed probable transient bulging fontanelle in a 9 month infant weighing 7.8Kg with ultrasound in Arba Minch General Hospital after 12 hours of measles vaccination. A physical examination was conducted to confirm probable transient bulging fontanel. Treated with her mother’s breast milk at her home and visiting was done after three and five days. We used a measles vaccine adverse effect case report, to find potential transient bulging fontanelle (TBF) and to describe the characteristics of probable cases of TBF on admitted infant to Arba Minch General Hospital. The Infant was alert; a febrile to touch whose temperature measured at the left auxiliarysitewas37.8oc with non-tender, bulging and tense swelling that includes non-pulsatile anterior fontanelle size of 3cm.The infant was found with no fever, vomiting, bleeding and no problem of feeding and respiratory difficulties except a history of fallen down accident from bed on her head 15 days back of the swelling. The swelling was decreased gradually and the fontanel started pulsation and the swelling returned back to the normal after the three and five day of visits without any medication. Despite this rare side effect, vaccination against the preventable disease, measles need to be sustained since transient bulging fontanelle is a self-limited case and immunization balances the impact of adverse events following immunization. Adequate case surveillance, diagnosis and reporting are very essential up to the management.


Keywords: Anterior fontanelle; Bulging; Immunization; Infant; Measles

Free Full-text PDF


How to cite this article:

Silabat Aschalew, Sisay Legesse, Abate Waldetensai. Probable Transient Anterior Bulging Fontanelle after Measles Vaccination: A Case in Arba Minch General Hospital, Southwestern Ethiopia. International Journal of Case Reports, 2019 9:93.


References:

1. D’Antoni AV, Donaldson O I, Schmidt C, Macchi V, De Caro R, Oskouian RJ, … Shane Tubbs, R. A comprehensive review of the anterior fontanelle: embryology, anatomy, and clinical considerations. Child’s Nervous System, 2017; 33(6: 909–914. https://doi.org/10.1007/s00381-017-3406-1
2. Esmaeili Mo, Esmaeili Ma, Ghane Sharbaf FBS. Fontanel Size from Birth to 24 Months of Age in Iranian Children. Iranian Journal of Child Neurology, 2015; 9(4): 15–23.
3. Fernandez-Pol C, Ben Wallenstein M, Chua I. Acute-onset Vomiting, Fever, and Bulging Fontanelle in a 7-month-old Boy. Pediatrics in Review, 2016; 37(12): 536–538. https://doi.org/10.1542/pir.2016-0077
4. Freedman SB, Reed J, Burwen DR, Wise RP, Weiss A, Ball R. Transient bulging fontanelle after vaccination: Case report and review of the vaccine adverse event reporting system. Journal of Pediatrics, 2005; 147(5): 640–644. https://doi.org/10.1016/j.jpeds.2005.06.009
5. Goldberg EM. Fever and bulging fontanelle mimicking meningitis in an infant diagnosed with benign intracranial hypertension. Pediatric Emergency Care, 2013; 29(4): 513–514. https://doi.org/10.1097/PEC.0b013e31828a3a28
6. Kiesler J, Ricer Ri. The Abnormal Fontanel. American Family Physician, 2003; 67(12): 2547–2552.
7. Maglione MA, Gidengil C, Das L, Raaen L, Smith A, Chari R, Bidwell Goetz M. Safety of Vaccines Used for Routine Immunization in the United States, 2014. https://doi.org/10.23970/AHRQEPCERTA215
8. Örtqvist Ä, Blennow M, Carlsson RM, Hanson L, Lindber A, Lindqvist L, … Trollfors B. Vaccination of children – A systematic review. Acta Paediatrica, International Journal of Paediatrics, (2010); 99(SUPPL. 461): 1–192. https://doi.org/10.1111/j.1651-2227.2010.01823.x
9. Oumer M, Guday E, Teklu A, Muche A. Anterior fontanelle size among term neonates on the first day of life born at University of Gondar Hospital , Northwest Ethiopia. PLOS ONE, 2018; 13(10): 1–13. Retrieved from https://doi.org/10.1371/journal.pone.0202454
10. Raju S S, Chacko B. Transient bulging fontanelle after measles vaccination. Indian Pediatrics, 2014; 51(8): 673–673. https://doi.org/10.1007/s13312-014-0478-9
11. Tu YF, Chuang HY, Huang CC, Chuang CC, Wang SM, Tsai MC, … Chuang MC. Frequency and prediction of abnormal findings on neuroimaging of infants with bulging anterior fontanelles. Academic Emergency Medicine, 2005; 12(12): 1185–1190. https://doi.org/10.1197/j.aem.2005.05.038