She seems to fall between CDC guidelines in that she clearing is outside of the four hour window which would indicate immediate reaction (CBC guidelines indicate even without systemic symptoms, if hives develop within four hours, then a second dose should be avoided). The allergy specific question is as follows: should the patient receive the second Pfizer vaccine dose? Hives lingered and ultimately seemed to improve with oral steroids and antihistamines but the patient developed a (seemingly secondary) non-urticarial rash on her face that persistent for weeks (Derm consult infectious vs inflammatory). PCP eval describes urticarial rash on the neck and face, very itchy. 18-24 hours later she developed 'hives'. Patient received Pfizer brand COVID-19 vaccine dose number one. Allergy history includes mild allergic rhinitis (dander, dust mite), itching with Vicodin and Latex in the past, reaction to MRI contrast in the past (itching, swelling, nausea, vomiting, hives). 51 year old female patient (teacher, wants fully vaccinated ASAP). 9 As the mRNA vaccines provide genetic information for the synthesis of SARS‐CoV‐2 spike protein, we postulate that a similar, albeit narrower range of autoantibodies may be induced.Please advise on the following situation. 7, 8 COVID‐19 infections were found to increase autoantibodies targeting a wide variety of tissues. Infections and vaccines can occasionally cause new‐onset or flare of autoimmune‐mediated diseases. Whilst it is possible that the dermatomyositis is coincidental to administration of the vaccine, the balance of probability given the temporal relationship and the severity of the symptoms following the first dose makes it difficult to recommend completing the vaccination regime. The patient did not receive the second dose in view of the adverse event after the first dose. 2, 3, 4 Whilst there have been reported cases of exacerbation of autoimmune disorders such as subacute cutaneous lupus erythematosus flare triggered by COVID‐19 vaccine, 5, 6 we describe, in this report, a novel case of dermatomyositis as an adverse reaction to mRNA COVID‐19 vaccine, with no prior history of connective tissue disorder.
#COVID RASH VACCINE SKIN#
At last follow‐up, his prednisolone dose has been tapered to 10 mg per day.Ī spectrum of cutaneous reactions has been reported with both Moderna and Pfizer mRNA COVID‐19 vaccines, 1 with most skin biopsies showing a range of spongiotic and interface changes. Intravenous immunoglobulin infusion and hydroxychloroquine was subsequently added, resulting in resolution of symptoms and normalization of his serum muscle enzymes. The rashes and systemic symptoms improved after the treatment but worsened each time prednisolone was tapered below 20 mg per day. The patient was initially given topical corticosteroid and a tapering course of oral prednisolone. The patient declined muscle biopsy and further evaluation for malignancy.
Chest radiograph had no features of interstitial lung disease. However, no immune deposits were noted on direct immunofluorescence. Dermal mucin was increased as highlighted by Alcian Blue stain (Figure 1D). Histopathological examination revealed epidermal atrophy, attenuation of the rete ridges and vacuolar interface changes, associated with sparse dermal inflammatory infiltrate composed of lymphocytes and no eosinophils (Figure 1C).
Skin punch biopsy of a chest lesion was performed. Needle electromyography revealed spontaneous insertional activity with fibrillation potentials, positive sharp waves, and small polyphasic motor unit potentials in the proximal upper and lower limbs, suggestive of a myopathic disorder. An extended myositis antibody panel did not detect the presence of myositis‐specific or myositis‐associated antibodies. Anti‐extractable nuclear antigens antibody tests (Smith, ribonucleoprotein, Ro, La, Scl‐70, Jo‐1) were negative. Anti‐nuclear antibody test was positive with a titer of 1:160 (nucleolar staining pattern), but anti‐double‐stranded DNA antibody levels and serum complements (C3 and C4) were within normal range.
#COVID RASH VACCINE FULL#
Full blood count, urea and electrolyte levels, and thyroid‐stimulating hormone levels were unremarkable. Erythrocyte sedimentation rate was elevated at 56 mm/hr. Laboratory investigations showed raised muscle enzymes with serum aldolase levels of 6.8 U/L and alanine transaminase levels of 70 U/L. (D) Mucin, highlighted by special stain Alcian blue, is noted in the superficial dermis
(C) Histology from the punch biopsy of the chest lesion shows epidermal atrophy, vacuolar interphase changes with sparse inflammatory infiltrate.
(A) and (B) Erythematous rash with telangiectasis on chest and both medial cheeks sparing nasolabial folds.
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