A cutaneous granulomatous eruption following rubella vaccination is a rarely reported phenomenon. It was initially identified in children with inherited immunodeficiency disorders and now is noted to occur in immunocompromised and immunocompetent adults. Case reports of granulomatous reactions to wild-type rubella virus have been documented in adults with or without immunodeficiency. In some cases, granulomas have been identified in the spleen, lymph nodes, bone marrow, brain, lungs, along the gastrointestinal tract, and in other abdominal organs.

The pathogenesis of granuloma formation has not been fully elucidated; however, it has been shown that the rubella virus persists in macrophages and neutrophils in these patients. There is a wide variability of disease onset, with lesions occurring between 3 weeks to decades following wild-type or vaccine-derived rubella.