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Faraji N, Goli R, Mohsennezhad P, Mohammadpour Y, Parizad N, Salamat E, Pourbahram R, Bazbandi S. NSAID (nonsteroidal anti-inflammatory drugs) Induced Stevens Johnson Syndrome in a 50-year-old woman: A case study. Toxicol Rep 2024; 12:289-291. [PMID: 38469333 PMCID: PMC10925921 DOI: 10.1016/j.toxrep.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 03/13/2024] Open
Abstract
Stevens-Johnson Syndrome (SJS) is a severe and rare adverse drug reaction associated with significant morbidity and mortality. Although SJS is commonly triggered by multiple drugs, non-steroidal anti-inflammatory drugs (NSAIDs), including diclofenac, have been frequently implicated. A middle-aged woman, who is 50 years old, has a prior medical record of high blood pressure, type 2 diabetes, and has recently suffered from a pulmonary embolism. She was later admitted to the intensive care unit (ICU), where she was ultimately diagnosed with Steven Johnson syndrome. Careful drug selection, close monitoring of patients with predisposing factors, and prompt identification of adverse events are crucial to prevent severe drug reactions.
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Affiliation(s)
- Navid Faraji
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Rasoul Goli
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Pariya Mohsennezhad
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Islamic Azad University, Urmia, Iran
| | - Yousef Mohammadpour
- Department of Medical Education, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Naser Parizad
- Patient Safety Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Elaheh Salamat
- Department of Anesthesia and Surgical Technology, School of Allied Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Raheleh Pourbahram
- Department of Nursing, School of Nursing and Midwifery, Islamic Azad University Chalus, Iran
| | - Samaneh Bazbandi
- Department of Anesthesiology, School of Nursing and Midwifery, Islamic Azad University Tehran Medical sciences, Tehran, Iran
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2
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Wali S, Gutte S, Pandey G, Kumar A, Gurjar M, Chahar JS. Toxic Epidermal Necrolysis After COVID-19 Vaccination: A Case Report and Review of Literature. J Acute Med 2024; 14:94-97. [PMID: 38855049 PMCID: PMC11153313 DOI: 10.6705/j.jacme.202406_14(2).0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/26/2023] [Indexed: 06/11/2024]
Abstract
Following vaccination for COVID-19, various cutaneous adverse reactions (CARs) are reported. Here is an Asian male in late 50's who developed necrotic skin with mucosal involvement 10 days following booster dose of ChAdOx1 nCov-19 vaccination. Based on disease course and morphology, toxic epidermal necrolysis (TEN) was suspected. The patient developed respiratory distress and was intubated, intravenous immunoglobulin (IVIG) administered at 2 g/kg body weight following which skin lesions healed in fourth week, the patient was discharged after 50 days of intensive care unit (ICU) stay. Severe CARs are rare following vaccination, of two components in ChAdOx1nCoV-19 adenoviral vector vaccine, virotopes cause T-cell mediated granulysin and granzyme B release leading to epidermal detachment and mucosal involvement of conducting airways causing respiratory failure. CARs can also occur in whom first and second dose was uneventful. Supportive therapy and prevention of sepsis are mainstay of management. Though the use of IVIG has shown conflicting results, our case was successfully managed with IVIG.
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Affiliation(s)
- Sachin Wali
- Sanjay Gandhi Postgraduate Institute of Medical Sciences Department of Critical Care Medicine Lucknow India
| | - Shreyas Gutte
- Sanjay Gandhi Postgraduate Institute of Medical Sciences Department of Critical Care Medicine Lucknow India
| | - Gaurav Pandey
- Command Hospital Air Force Department of Anaesthesiology and Critical Care Bengaluru India
| | - Ajit Kumar
- Sanjay Gandhi Postgraduate Institute of Medical Sciences and Research Centre Consultant Dermatology Lucknow India
| | - Mohan Gurjar
- Sanjay Gandhi Postgraduate Institute of Medical Sciences Department of Critical Care Medicine Lucknow India
| | - Jitendra Singh Chahar
- Sanjay Gandhi Postgraduate Institute of Medical Sciences Department of Critical Care Medicine Lucknow India
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3
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Gubernot D, Menis M, Whitaker B. Background rates for severe cutaneous reactions in the US: Contextual support for safety assessment of COVID-19 vaccines and novel biologics. Vaccine 2023; 41:6922-6929. [PMID: 37891051 DOI: 10.1016/j.vaccine.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/11/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023]
Abstract
The global COVID-19 public health crisis has resulted in extraordinary collaboration to expeditiously develop vaccines and therapeutics. The safety of these biologics is closely monitored by the US Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC). Novel products may have limited safety data, and although serious medical outcomes associated with vaccination are rare, knowledge of background incidence rates of medical conditions in the US population puts reported adverse events (AEs) in perspective for further study. Although relatively minor vaccination skin reactions are common, rare instances of severe delayed hypersensitivity reactions such as erythema multiforme (EM), Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap syndrome may occur. To aid in the assessment of these events, we performed a literature search in PubMed and Web of Science on the background incidence of EM, SJS, SJS/TEN, and TEN in the US population and on published reports of these conditions occurring post-vaccination. The US background annual incidence rates per million individuals of all ages ranged from 5.3 to 63.0 for SJS, from 0.4 to 5.0 for TEN, and from 0.8 to 1.6 for SJS/TEN. Since these conditions may overlap, some studies reported rates for EM/SJS/TEN combined, however we did not find studies with exclusive EM incidence rates. The published literature, including studies of reports submitted to the FDA/CDC Vaccine Adverse Event Reporting System (VAERS), describes post-vaccination EM, SJS, SJS/TEN and/or TEN as rare occurrences. The vaccines most frequently associated with these conditions were measles, mumps, and rubella; diphtheria, tetanus, and pertussis; and varicella. The majority of VAERS reports of EM, SJS, SJS/TEN, or TEN occurred in children within 30 days of vaccination. This review summarizes background rates of these disorders in the general population and published AEs among vaccine recipients, to support safety surveillance of COVID-19 vaccines and other biologics.
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Affiliation(s)
- Diane Gubernot
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, 10903 New Hampshire Avenue, Silver Spring, MD 20993, United States.
| | - Mikhail Menis
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, 10903 New Hampshire Avenue, Silver Spring, MD 20993, United States.
| | - Barbee Whitaker
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, 10903 New Hampshire Avenue, Silver Spring, MD 20993, United States.
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4
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Ebrahimi M, Aghapour SA, Rashidbaghan A, Mazandarani M. Stevens-Johnson syndrome and COVID-19: a case report with suspected multisystem inflammatory syndrome in children (MIS-C). Ann Med Surg (Lond) 2023; 85:5641-5644. [PMID: 37915708 PMCID: PMC10617869 DOI: 10.1097/ms9.0000000000001087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 07/09/2023] [Indexed: 11/03/2023] Open
Abstract
Introduction and importance Symptoms similar to diseases such as Stevens-Johnson syndrome (SJS) and multisystemic inflammatory syndrome in children (MIS-C) were reported in pediatric coronavirus infections. Case presentation Here, we present a 4-year-old girl with coronavirus disease 2019 (COVID-19), an earlier diagnosis of SJS, and a final diagnosis of MIS-C. Clinical discussion Unlike the negative PCR test for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the positive serological test confirmed COVID-19. Conclusion The monitoring of this case indicated that higher coronavirus infection can delay immune reaction and cause symptoms similar to SJS.
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Affiliation(s)
| | - Seyed Ali Aghapour
- Neonatal and Children’s Health Research Center, Golestan University of Medical Sciences, Gorgan, Iran
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Blumenthal KG, Greenhawt M, Phillips EJ, Agmon-Levin N, Golden DBK, Shaker M. An Update in COVID-19 Vaccine Reactions in 2023: Progress and Understanding. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3305-3318. [PMID: 37414339 DOI: 10.1016/j.jaip.2023.06.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/24/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
It has been 3 years since the coronavirus disease 2019 (COVID-19) pandemic was initially declared, and 2 years have passed since the first COVID-19 vaccines were introduced. Since then, 13.2 billion COVID-19 vaccine doses have been administered worldwide, largely with multiple doses of messenger RNA vaccines. Although mild local and systemic adverse effects after COVID-19 vaccination are common, serious adverse effects following immunization are rare, particularly when compared with the large number of vaccine doses administered. Immediate and delayed reactions are relatively common and present similarly to allergic and hypersensitivity reactions. Despite this, reactions generally do not commonly recur, cause sequelae, or contraindicate revaccination. In this Clinical Management Review, we provide an updated perspective of COVID-19 vaccine reactions, their spectrum and epidemiology, and recommended approaches to evaluation and management.
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Affiliation(s)
- Kimberly G Blumenthal
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; The Mongan Institute, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
| | - Matthew Greenhawt
- Department of Pediatrics, Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado Denver School of Medicine, Denver, Colo
| | - Elizabeth J Phillips
- Center for Drug Safety and Immunology, Departments of Medicine, Dermatology, Pharmacology, Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, Tenn
| | - Nancy Agmon-Levin
- The Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Marcus Shaker
- Dartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, Lebanon, NH; Geisel School of Medicine at Dartmouth, Hanover, NH
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Bin Rubaian NF, Aljalfan AA, Almuhaidib SR. Management of coronavirus disease 2019 vaccine-induced cutaneous complications: A comprehensive literature review. J Family Community Med 2023; 30:161-170. [PMID: 37675215 PMCID: PMC10479027 DOI: 10.4103/jfcm.jfcm_3_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/12/2023] [Accepted: 05/29/2023] [Indexed: 09/08/2023] Open
Abstract
Despite the numerous reports of cutaneous manifestations associated with vaccines for coronavirus disease 2019 (COVID-19), the relationship between COVID-19 vaccines and cutaneous side effects remains unevaluated. In this review, we examine these manifestations and their management. Reported dermatoses included injection-site reaction (early and delayed), type I allergic reaction, morbilliform eruption, pityriasis rosea, Sweet syndrome, lichen planus, psoriasis, herpes zoster reactivation, erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis (TEN). The most common COVID-19 vaccination-related cutaneous manifestations are delayed local reactions, approximately 66% of which are associated with the Moderna vaccine, and 33% with the Pfizer vaccine. Aside from mild injection-site reactions, severe reactions include anaphylaxis and TEN. Most reactions, except for Stevens-Johnson syndrome and anaphylaxis, though unpredictable and unpreventable are mild and can be treated symptomatically. Findings from this review should allow primary care physicians and dermatologists to reach faster diagnosis and initiate prompt intervention.
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Affiliation(s)
- Nouf F. Bin Rubaian
- Department of Dermatology, King Fahad University Hospital, Al-Khobar, Saudi Arabia
| | - Abdullah A. Aljalfan
- Department of Dermatology, King Fahad University Hospital, Al-Khobar, Saudi Arabia
| | - Serene R. Almuhaidib
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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7
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Zou H, Daveluy S. Toxic epidermal necrolysis and Stevens-Johnson syndrome after COVID-19 infection and vaccination. Australas J Dermatol 2022; 64:e1-e10. [PMID: 36484649 PMCID: PMC9878214 DOI: 10.1111/ajd.13958] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/11/2022] [Accepted: 11/20/2022] [Indexed: 12/14/2022]
Abstract
Stevens-Johnson Syndrome (SJS) is a rare but severe skin reaction characterized by blistering and peeling of the skin and ulcerations of mucous membranes; toxic epidermal necrolysis (TEN) is a subset of SJS characterized by the involvement of >30% of the skin. Though previously associated with drugs and infections, discussions on the association between TEN/SJS and COVID-19 have been limited. We present a review of TEN/SJS after COVID-19 infection and vaccination. Literature searches were conducted on PubMed and Google Scholar from 2019 to 8/2022. Thirty-eight articles were selected based on subject relevance, and references within selected articles were also screened for relevance. As of 8/2022, there have been 34 published cases of TEN, SJS, and SJS-TEN overlap after COVID-19 infection and vaccination, including 12 cases after vaccination and 22 cases after infection. Multiple authors hypothesize that virotopes or excipients in COVID-19 vaccines can activate T-cells or cytokines to induce TEN/SJS. Meanwhile, some hypothesize that COVID-19 infection induces immune activation that can trigger TEN/SJS or increase susceptibility to drug-induced TEN/SJS. Treatments for post-infection and post-vaccination TEN/SJS vary significantly. We recommend remaining vigilant for this rare and severe potential complication.
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Affiliation(s)
- Henry Zou
- Michigan State University College of Human MedicineGrand RapidsMichiganUSA
| | - Steven Daveluy
- Department of DermatologyWayne State University School of MedicineDetroitMichiganUSA
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8
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Shakoei S, hadizadeh A. Toxic epidermal necrosis following Sinopharm
COVID
‐19 vaccine (
BBIBP‐CorV
): A case report and literature review. Clin Case Rep 2022; 10:e6726. [PMCID: PMC9748221 DOI: 10.1002/ccr3.6726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 10/15/2022] [Accepted: 11/26/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Safoura Shakoei
- Department of Dermatology Imam Khomeini Hospital complex, Tehran University of Medical Sciences (TUMS) Tehran Iran
| | - Alireza hadizadeh
- Department of Dermatology Imam Khomeini Hospital complex, Tehran University of Medical Sciences (TUMS) Tehran Iran
- Research center for advanced technologies in cardiovascular medicine cardiovascular diseases research institute, Tehran university of medical sciences Tehran Iran
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9
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Sljivic S, Pogson K, Williams FN, Nizamani R, King BT. COVID-induced toxic epidermal necrolysis in a 4-year-old female: a case report and literature review. INTERNATIONAL JOURNAL OF BURNS AND TRAUMA 2022; 12:204-209. [PMID: 36420101 PMCID: PMC9677226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/28/2022] [Indexed: 12/24/2022]
Abstract
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are conditions characterized by an immune-mediated skin reaction that results in blistering and epidermal detachment. Most cases are caused by drug hypersensitivity; however, recently there have been many publications documenting the association between coronavirus disease 2019 (COVID-19) and SJS/TEN. Our objective is to explore a case of a 4-year-old female who presented with a papular rash on her thighs that progressively worsened and spread to her face, trunk, and genital area. The patient tested positive for COVID-19. She required treatment with intravenous immunoglobulin (IVIG) and IV methylprednisolone, but eventually made a full recovery. This case underscores the need for awareness of the wide spectrum of dermatologic presentations in COVID-19 patients.
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Affiliation(s)
- Sanja Sljivic
- Department of Surgery, University of North Carolina School of MedicineChapel Hill, NC, USA,North Carolina Jaycee Burn CenterChapel Hill, NC, USA
| | - Kaylyn Pogson
- University of North Carolina School of MedicineChapel Hill, NC, USA
| | - Felicia N Williams
- Department of Surgery, University of North Carolina School of MedicineChapel Hill, NC, USA,North Carolina Jaycee Burn CenterChapel Hill, NC, USA
| | - Rabia Nizamani
- Department of Surgery, University of North Carolina School of MedicineChapel Hill, NC, USA,North Carolina Jaycee Burn CenterChapel Hill, NC, USA
| | - Booker T King
- Department of Surgery, University of North Carolina School of MedicineChapel Hill, NC, USA,North Carolina Jaycee Burn CenterChapel Hill, NC, USA
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10
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Rodríguez Y, Rojas M, Beltrán S, Polo F, Camacho-Domínguez L, Morales SD, Gershwin ME, Anaya JM. Autoimmune and autoinflammatory conditions after COVID-19 vaccination. New case reports and updated literature review. J Autoimmun 2022; 132:102898. [PMID: 36041291 PMCID: PMC9399140 DOI: 10.1016/j.jaut.2022.102898] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/11/2022] [Accepted: 08/14/2022] [Indexed: 11/20/2022]
Abstract
Autoimmunity linked to COVID-19 immunization has been recorded throughout the pandemic. Herein we present six new patients who experienced relapses of previous autoimmune disease (AD) or developed a new autoimmune or autoinflammatory condition following vaccination. In addition, we documented additional cases through a systematic review of the literature up to August 1st, 2022, in which 464 studies (928 cases) were included. The majority of patients (53.6%) were women, with a median age of 48 years (IQR: 34 to 66). The median period between immunization and the start of symptoms was eight days (IQR: 3 to 14). New-onset conditions were observed in 81.5% (n: 756) of the cases. The most common diseases associated with new-onset events following vaccination were immune thrombocytopenia, myocarditis, and Guillain-Barré syndrome. In contrast, immune thrombocytopenia, psoriasis, IgA nephropathy, and systemic lupus erythematosus were the most common illnesses associated with relapsing episodes (18.5%, n: 172). The first dosage was linked with new-onset events (69.8% vs. 59.3%, P = 0.0100), whereas the second dose was related to relapsing disease (29.5% vs. 59.3%, P = 0.0159). New-onset conditions and relapsing diseases were more common in women (51.5% and 62.9%, respectively; P = 0.0081). The groups were evenly balanced in age. No deaths were recorded after the disease relapsed, while 4.7% of patients with new-onset conditions died (P = 0.0013). In conclusion, there may be an association between COVID-19 vaccination and autoimmune and inflammatory diseases. Some ADs seem to be more common than others. Vaccines and SARS-CoV-2 may induce autoimmunity through similar mechanisms. Large, well-controlled studies are warranted to validate this relationship and assess additional variables such as genetic and other environmental factors.
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Affiliation(s)
- Yhojan Rodríguez
- Clínica del Occidente, Bogota, Colombia; Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Manuel Rojas
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Santiago Beltrán
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Fernando Polo
- Hospital Infantil de San José, Fundación Universitaria de Ciencias de la Salud. Department of Pathology, Bogota, Colombia
| | - Laura Camacho-Domínguez
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Samuel David Morales
- Hospital Infantil de San José, Fundación Universitaria de Ciencias de la Salud. Department of Pathology, Bogota, Colombia
| | - M Eric Gershwin
- Division of Rheumatology, Allergy and Clinical Immunology, University of California, Davis, Davis, CA, United States
| | - Juan-Manuel Anaya
- Clínica del Occidente, Bogota, Colombia; LifeFactors, Rionegro, Colombia.
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11
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Zang X, Chen S, Zhang L, Zhai Y. Toxic epidermal necrolysis in hepatitis A infection with acute-on-chronic liver failure: Case report and literature review. Front Med (Lausanne) 2022; 9:964062. [PMID: 36213642 PMCID: PMC9537471 DOI: 10.3389/fmed.2022.964062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/29/2022] [Indexed: 11/25/2022] Open
Abstract
Toxic epidermal necrolysis (TEN) and Stevens–Johnson syndrome (SJS) are acute inflammatory skin adverse reactions characterized by epidermal exfoliation and multi-site mucositis and are considered medical emergencies. The risk factors for SJS/TEN include immune disorders, malignancy, and genetic susceptibility. In most cases, medication is considered to be the leading cause of TEN. In addition, several studies suggest that infections, such as the herpes simplex virus, human immunodeficiency virus (HIV), Mycoplasma pneumoniae, streptococcus, and meningococcus infections, can trigger the occurrence of SJS/TEN. In this rare case, we share our experience managing TEN in a hepatitis A virus infection with an acute-on-chronic liver failure patient. A 38-year-old man was infected with hepatitis A virus on the basis of liver cirrhosis and progressed to acute-on-chronic liver failure. As the infection progressed, the target-like skin lesions accompanied by mucosal involvement worsened. The condition of the patient progressively worsened with a severe generalized rash, bullae, and epidermal detachment accompanied by severe erosive mucosal lesions. His skin detachment area gradually involved 30% of the body surface area (BSA), and the disease progressed to TEN. The intravenous infusion of corticosteroids alleviated the patient's hypersensitivity, and the patient obtained lasting remission without severe adverse reactions and complications.
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Affiliation(s)
- Xin Zang
- Department of Infectious Disease, Shengjing Hospital of China Medical University, Shenyang, China
| | - Si Chen
- Department of Neurology, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Lin Zhang
- Department of Infectious Disease, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yongzhen Zhai
- Department of Infectious Disease, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Yongzhen Zhai
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12
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Corey KB, Koo G, Phillips EJ. Adverse Events and Safety of SARS-CoV-2 Vaccines: What's New and What's Next. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2254-2266. [PMID: 35550878 PMCID: PMC9085443 DOI: 10.1016/j.jaip.2022.04.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 12/29/2022]
Abstract
Just over 1 year following rollout of the first vaccines for coronavirus disease 2019, 572 million doses have been administered in the United States. Compared with the number of vaccines administered, adverse effects such as anaphylaxis have been rare, and seemingly, the more serious the effect, the rarer the occurrence. Despite these adverse effects, there are few, if any, true contraindications to coronavirus disease 2019 vaccination and most individuals recover without further sequelae. This review provides guidance for the allergist/immunologist regarding appropriate next steps based on patient's known allergy history or adverse reaction after receipt of coronavirus disease 2019 vaccine to assist in safe global immunization.
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Affiliation(s)
- Kristen B Corey
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Grace Koo
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Elizabeth J Phillips
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn; Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, WA, Australia.
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13
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Khazeei Tabari MA, Najary S, Khadivi G, Yousefi MJ, Samieefar N, Abdollahimajd F. Oral lesions after COVID-19 vaccination: Immune mechanisms and clinical approach. INFECTIOUS MEDICINE 2022; 1:171-179. [PMID: 38014364 PMCID: PMC9212505 DOI: 10.1016/j.imj.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/08/2022] [Accepted: 06/16/2022] [Indexed: 11/11/2022]
Abstract
COVID-19 vaccination, although is a promising tool to overcome the pandemic, has side effects. There are increasing reports of oral lesions after COVID-19 vaccination. The aim of this review is to identify the occurrence of some oral lesions after COVID-19 vaccination, and highlight the underlying immune mechanisms involved. A narrative literature review was performed by searching electronic databases including PubMed, Scopus and Web of Science to investigate the oral lesions after COVID-19 vaccination. The inclusion criteria were original studies, including the case reports, case series, letter to the editor, and cross-sectional studies. The exclusion criteria included the studies which examined the oral lesions caused by COVID-19 infection. The information, including the number of participant(s) receiving vaccine, type of vaccine, dose number, side effect(s), time of onset following vaccination, healing time, treatment strategies for the existing lesions, and related mechanisms were then summarized in a data extraction sheet. The results of this review showed that some vaccines had side effects with oral involvement such as pemphigus vulgaris, bullous pemphigoid, herpes zoster, lichen planus, Stevens-Johnson syndrome and Behçet's disease. Future research needs to elucidate the physiopathology of oral manifestations after the COVID-19 vaccination, and better understand the risk factors associated with such responses. Sometimes vaccine's side effects may be due to the nocebo effect, which means that the person expects some adverse events to occur following the vaccine administration.
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Affiliation(s)
- Mohammad Amin Khazeei Tabari
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
- USERN Office, Mazandaran University of Medical Sciences, Sari, Iran
| | - Shaghayegh Najary
- School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- USERN Office, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gita Khadivi
- School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- USERN Office, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Yousefi
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
- USERN Office, Babol University of Medical Sciences, Babol, Iran
| | - Noosha Samieefar
- USERN Office, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Abdollahimajd
- USERN Office, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Clinical Research Development Unit, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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14
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Wang L, Varghese S, Bassir F, Lo YC, Ortega CA, Shah S, Blumenthal KG, Phillips EJ, Zhou L. Stevens-Johnson syndrome and toxic epidermal necrolysis: A systematic review of PubMed/MEDLINE case reports from 1980 to 2020. Front Med (Lausanne) 2022; 9:949520. [PMID: 36091694 PMCID: PMC9449801 DOI: 10.3389/fmed.2022.949520] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, life-threatening immunologic reactions. Prior studies using electronic health records, registries or reporting databases are often limited in sample size or lack clinical details. We reviewed diverse detailed case reports published over four decades. Methods Stevens-Johnson syndrome and toxic epidermal necrolysis-related case reports were identified from the MEDLINE database between 1980 and 2020. Each report was classified by severity (i.e., SJS, TEN, or SJS-TEN overlap) after being considered a “probable” or “definite” SJS/TEN case. The demographics, preconditions, culprit agents, clinical course, and mortality of the cases were analyzed across the disease severity. Results Among 1,059 “probable” or “definite” cases, there were 381 (36.0%) SJS, 602 (56.8%) TEN, and 76 (7.2%) SJS-TEN overlap cases, with a mortality rate of 6.3%, 24.4%, and 21.1%, respectively. Over one-third of cases had immunocompromised conditions preceding onset, including cancer (n = 194,18.3%), autoimmune diseases (n = 97, 9.2%), and human immunodeficiency virus (HIV) (n = 52, 4.9%). During the acute phase of the reaction, 843 (79.5%) cases reported mucous membrane involvement and 210 (19.8%) involved visceral organs. Most cases were drug-induced (n = 957, 90.3%). A total of 379 drug culprits were reported; the most frequently reported drug were antibiotics (n = 285, 26.9%), followed by anticonvulsants (n = 196, 18.5%), analgesics/anesthetics (n = 126, 11.9%), and antineoplastics (n = 120, 11.3%). 127 (12.0%) cases reported non-drug culprits, including infections (n = 68, 6.4%), of which 44 were associated with a mycoplasma pneumoniae infection and radiotherapy (n = 27, 2.5%). Conclusion An expansive list of potential causative agents were identified from a large set of literature-reported SJS/TEN cases, which warrant future investigation to understand risk factors and clinical manifestations of SJS/TEN in different populations.
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Affiliation(s)
- Liqin Wang
- Division of General Internal Medicine and Primary Care, Department of Medicine, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, United States
- *Correspondence: Liqin Wang,
| | - Sheril Varghese
- Division of General Internal Medicine and Primary Care, Department of Medicine, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, United States
| | - Fatima Bassir
- Division of General Internal Medicine and Primary Care, Department of Medicine, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, United States
| | - Ying-Chin Lo
- Division of General Internal Medicine and Primary Care, Department of Medicine, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, United States
| | - Carlos A. Ortega
- School of Medicine, Vanderbilt University, Nashville, TN, United States
| | - Sonam Shah
- Division of General Internal Medicine and Primary Care, Department of Medicine, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Kimberly G. Blumenthal
- Division of Rheumatology, Allergy, and Immunology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
| | - Elizabeth J. Phillips
- Division of Infectious Disease, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Li Zhou
- Division of General Internal Medicine and Primary Care, Department of Medicine, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, United States
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15
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Nanamori H, Sawada Y, Sato S, Hara R, Minokawa Y, Sugino H, Saito‐Sasaki N, Yamamoto K, Okada E, Nakamura M. Prior antihistamine agent successfully impaired cutaneous adverse reactions to
COVID
‐19 vaccine. JOURNAL OF CUTANEOUS IMMUNOLOGY AND ALLERGY 2022. [PMCID: PMC9349828 DOI: 10.1002/cia2.12248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The coronavirus disease 2019 (COVID‐19) vaccine is positively changing the health crises of this pandemic and is currently essential to overcome the COVID‐19 pandemic. The vaccine shows high efficacy against the infection and impairs the severity of symptoms. However, this vaccination is associated with concerns, such as vaccine‐associated adverse reactions, which are currently highlighted issues for clinicians. We experienced two cases of mild cutaneous adverse reaction following COVID‐19 vaccine administration, which was successfully controlled by prior administration of the antihistamine agent fexofenadine 3 days before COVID‐19 vaccination for 7 days.
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Affiliation(s)
- Hikaru Nanamori
- Department of Dermatology University of Occupational and Environmental Health Kitakyushu Japan
| | - Yu Sawada
- Department of Dermatology University of Occupational and Environmental Health Kitakyushu Japan
| | - Sayaka Sato
- Department of Dermatology University of Occupational and Environmental Health Kitakyushu Japan
| | - Reiko Hara
- Department of Dermatology University of Occupational and Environmental Health Kitakyushu Japan
| | - Yoko Minokawa
- Department of Dermatology University of Occupational and Environmental Health Kitakyushu Japan
| | - Hitomi Sugino
- Department of Dermatology University of Occupational and Environmental Health Kitakyushu Japan
| | - Natsuko Saito‐Sasaki
- Department of Dermatology University of Occupational and Environmental Health Kitakyushu Japan
| | - Kayo Yamamoto
- Department of Dermatology University of Occupational and Environmental Health Kitakyushu Japan
| | - Etsuko Okada
- Department of Dermatology University of Occupational and Environmental Health Kitakyushu Japan
| | - Motonobu Nakamura
- Department of Dermatology University of Occupational and Environmental Health Kitakyushu Japan
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16
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Siripipattanamongkol N, Rattanasak S, Taiyaitieng C, Inthajak Y, Kuawatcharawong N, Sukasem C, Tempark T. Toxic epidermal necrolysis after first dose of Pfizer-BioNTech (BNT162b2) vaccination with pharmacogenomic testing. Pediatr Dermatol 2022; 39:601-605. [PMID: 36000937 PMCID: PMC9538630 DOI: 10.1111/pde.15074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/28/2022] [Indexed: 12/03/2022]
Abstract
Toxic epidermal necrolysis (TEN) is a rare and acute life-threatening condition and one of the severe cutaneous adverse drug reactions. There are limited data on TEN from the COVID-19 vaccine regarding its pathogenesis, treatment, and prognosis, particularly in children. We report a case of COVID-19 vaccine-induced TEN and the patient's human leukocyte antigen pharmacogenomic profile.
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Affiliation(s)
| | - Sirawich Rattanasak
- Departments of Pediatrics, Chiangrai Prachanukroh Hospital, Chiangrai, Thailand
| | - Chanya Taiyaitieng
- Departments of Medicine, Chiangrai Prachanukroh Hospital, Chiangrai, Thailand
| | - Yanapha Inthajak
- Departments of Ophthalmology, Chiangrai Prachanukroh Hospital, Chiangrai, Thailand
| | | | - Chonlaphat Sukasem
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Pharmacogenomics and Precision Medicine Clinic, The Preventive Genomics & Family Check-up Services Center, Bumrungrad International Hospital, Bangkok, Thailand.,MRC Centre for Drug Safety Science, Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Therdpong Tempark
- Department of Pediatrics, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
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17
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Seck B, Dieye A, Diallo M. Lethal Toxic Epidermal Necrolysis probably induced by Sinopharm COVID-19 vaccine. REVUE FRANÇAISE D'ALLERGOLOGIE 2022; 62:590-592. [PMID: 35855853 PMCID: PMC9276642 DOI: 10.1016/j.reval.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 07/07/2022] [Indexed: 10/25/2022]
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18
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Palaia G, Pernice E, Pergolini D, Impellizzeri A, Migliau G, Gambarini G, Romeo U, Polimeni A. Erythema Multiforme as Early Manifestation of COVID-19: A Case Report. Pathogens 2022; 11:pathogens11060654. [PMID: 35745508 PMCID: PMC9229542 DOI: 10.3390/pathogens11060654] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/03/2022] [Accepted: 06/05/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a viral infection involving multi-organ manifestations. The main oral symptoms of COVID-19 associated are taste loss and xerostomia, but literature has reported other oral manifestation, such as oral blisters, ulcers, vesicles and other immunological lesions. This case report showed an Erythema Multiforme (EM) manifesting as oral mucosa lesions in a patient with a late diagnosis of COVID-19 infection. Case Presentation: A 30 years-old Caucasian woman was sent to an oral medicine office, in order to manage painful and oral mucosa lesions associated with target symmetrical skin lesions. Oral examination revealed extensive ulcers in the mouth and crusts on the lips. Based on clinical examinations, a diagnosis of Erythema Multiforme major was made and a drug therapy with steroids was administered. Five days after the specialist visit, the patient discovered that she was positive for COVID-19. The complete recovery occurred in 3 weeks. Conclusion: Confirming the literature studies, EM is an early disease associated with COVID-19 infection.
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19
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ElSawi HA, Elborollosy A. Immune-mediated adverse events post-COVID vaccination and types of vaccines: a systematic review and meta-analysis. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2022; 34:44. [PMID: 35607386 PMCID: PMC9117608 DOI: 10.1186/s43162-022-00129-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/18/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
In late 2019, Coronavirus disease 2019 has been declared as a global emergency by World Health Organization. Hopefully, recent reports of effective and safe vaccines were welcomed, and approved on emergency base. Millions of recipients had received one of the approved COVID 19 vaccines, with lots of adverse events recorded global wide.
Objective
To assess post-COVID vaccination immune-mediated adverse events and evaluate its association to specific type of vaccine global wide.
Methods
Systematic literature review and meta-analysis of published reports (since December 2020 till December 2021) on immune-mediated adverse events post-COVID vaccination.
Results
We evaluated 34 published studies; 460 cases with various adverse events post-COVID vaccination. Studies in current literature are primarily retrospective case series, isolated case reports or narrative studies. Different COVID vaccines were involved. Results’ data was subcategorized according to associated vaccine. Adverse effects of COVID-19 vaccinations included thrombotic, neurological, myocarditis, ocular, dermatological, renal, hematological events timely linked to inoculation. Each vaccine type was linked to adverse profile that differ from others.
Conclusion
High suspicion of post-vaccination adverse events is mandatory to provoke earlier detection, better understanding, optimum prevention, and management. Specific vaccine/patient risk profile is needed to selectively categorize target population to reduce morbidity and mortality post-vaccination.
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20
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Padniewski JJ, Jacobson‐Dunlop E, Albadri S, Hylwa S. Stevens–Johnson
syndrome precipitated by Moderna Inc.
COVID
‐19 vaccine: a case‐based review of literature comparing vaccine and drug‐induced
Stevens–Johnson
syndrome/toxic epidermal necrolysis. Int J Dermatol 2022; 61:923-929. [PMID: 35398905 PMCID: PMC9111554 DOI: 10.1111/ijd.16222] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/05/2022] [Accepted: 03/22/2022] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Sam Albadri
- Department of Laboratory Medicine and Pathology Hennepin Healthcare Hennepin Minnesota USA
| | - Sara Hylwa
- Faculty Physician, Department of Dermatology Hennepin Healthcare Hennepin Minnesota USA
- Assistant Professor, Department of Dermatology University of Minnesota Minneapolis Minnesota USA
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21
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Cutaneous Complications of mRNA and AZD1222 COVID-19 Vaccines: A Worldwide Review. Microorganisms 2022; 10:microorganisms10030624. [PMID: 35336199 PMCID: PMC8953728 DOI: 10.3390/microorganisms10030624] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/07/2022] [Accepted: 03/09/2022] [Indexed: 02/07/2023] Open
Abstract
Because of the increasing emergence of cutaneous reactions from COVID-19 vaccines worldwide, we investigated the published reports of these complications. We searched the PubMed, Google Scholar, and Scopus databases and the preprint server bioRxiv for articles on cutaneous complications linked to mRNA-1273 (Moderna), BNT162b2 (Pfizer–BioNTech), and AZD1222 (AstraZeneca–Oxford University) vaccines published until 30 September 2021. Eighty studies describing a total of 1415 reactions were included. Cutaneous reactions were more prevalent in females (81.6%). Delayed large local reactions were the most common complication (40.4%), followed by local injection site reactions (16.5%), zoster (9.5%), and urticarial eruptions (9.0%). Injection site and delayed large local reactions were predominantly caused by the mRNA-1273 vaccine (79.5% and 72.0%, respectively). BNT162b2 vaccination was more closely linked to distant reactions (50.1%) than mRNA-1273 (30.0%). Zoster was the most common distant reaction. Of reactions with adequate information for both vaccine doses, 58.3% occurred after the first dose only, 26.9% after the second dose only, and 14.8% after both doses. Overall, a large spectrum of cutaneous reaction patterns occurred following the COVID-19 vaccination. Most were mild and without long-term health implications. Therefore, the occurrence of such dermatologic complications does not contraindicate subsequent vaccination.
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22
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Chun Y, Jang J, Jo JH, Park JW. Various painful oral adverse reactions following COVID-19 vaccination: a case series. BMC Oral Health 2022; 22:64. [PMID: 35260129 PMCID: PMC8902844 DOI: 10.1186/s12903-022-02100-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background Adverse events are increasingly being reported with the growing COVID-19 vaccination rate. However, the current literature on orofacial adverse effects following COVID-19 vaccination are severely limited. With the continuation of the global vaccination campaign the incidence of oral adverse effects will inevitably increase. Case presentation Clinical characteristics and treatment results of nine patients who complained of pain and discomfort of the oral cavity following SARS-CoV-2 vaccination were analyzed. Swelling and pain of the posterior palatal area, pain on palatal area of the central incisor, pain on the mucosa of the lip and lower gingiva, right preauricular region and right posterior lower gingiva, the buccal mucosa, tongue, and the right lower second molar area were the reported symptoms. Ulceration and swelling of the oral mucosa were found in certain cases. The symptoms were generally mild and responded well to medication within a relatively short period of time. Conclusion Oral adverse reactions following COVID-19 vaccination were manageable with treatment. Clinicians should understand the true nature of orofacial adverse reactions following COVID-19 vaccines and guide patients in decision-making.
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Affiliation(s)
- Youngwoo Chun
- Department of Oral Medicine, Seoul National University Dental Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Department of Oral Medicine and Oral Diagnosis, School of Dentistry, Seoul National University, 101 Daehak-ro, Jong-gu, Seoul, 03080, Republic of Korea
| | - Jihee Jang
- Department of Oral Medicine, Seoul National University Dental Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Department of Oral Medicine and Oral Diagnosis, School of Dentistry, Seoul National University, 101 Daehak-ro, Jong-gu, Seoul, 03080, Republic of Korea
| | - Jung Hwan Jo
- Department of Oral Medicine, Seoul National University Dental Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Department of Oral Medicine and Oral Diagnosis, School of Dentistry, Seoul National University, 101 Daehak-ro, Jong-gu, Seoul, 03080, Republic of Korea
| | - Ji Woon Park
- Department of Oral Medicine, Seoul National University Dental Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. .,Department of Oral Medicine and Oral Diagnosis, School of Dentistry, Seoul National University, 101 Daehak-ro, Jong-gu, Seoul, 03080, Republic of Korea. .,Dental Research Institute, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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23
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Mardani M, Mardani S, Asadi-Kani Z, Hakamifard A. An Extremely Rare Mucocutaneous Adverse Reaction Following COVID-19 Vaccination: Toxic Epidermal Necrolysis. Dermatol Ther 2022; 35:e15416. [PMID: 35238119 PMCID: PMC9111664 DOI: 10.1111/dth.15416] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/23/2022] [Accepted: 02/26/2022] [Indexed: 11/30/2022]
Abstract
Stevens‐Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN), is a type of delayed hypersensitivity reaction that requires urgent medical intervention. In the COVID‐19 era, COVID‐19 vaccines are currently being widely administered and mucocutaneous adverse reactions following vaccination have been reported; however, severe cutaneous adverse reactions associated with COVID‐19 vaccines including SJS/TEN, are extremely rare. Herein, we describe a case of COVID‐19 vaccination induced TEN which developed 1 day after receiving the first dose of Sinopharm COVID‐19 vaccine with favorable clinical outcome.
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Affiliation(s)
- Masoud Mardani
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sayna Mardani
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Asadi-Kani
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atousa Hakamifard
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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24
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Aimo C, Mariotti EB, Corrà A, Cipollini E, Le Rose O, Serravalle C, Pimpinelli N, Caproni M. Stevens-Johnson Syndrome induced by Vaxvetria (AZD1222) Covid-19 vaccine. J Eur Acad Dermatol Venereol 2022; 36:e417-e419. [PMID: 35133674 PMCID: PMC9114927 DOI: 10.1111/jdv.17988] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/12/2021] [Accepted: 01/07/2022] [Indexed: 11/28/2022]
Affiliation(s)
- C Aimo
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - E B Mariotti
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - A Corrà
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - E Cipollini
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - O Le Rose
- Azienda Usl Toscana Centro, P.O. Piero Palagi, Hospital, Florence, Italy
| | - C Serravalle
- Department of Internal Medicine, P.O. Nuovo Ospedale del Mugello, Azienda USL Toscana Centro, Florence, Italy
| | - N Pimpinelli
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - M Caproni
- Rare Diseases Unit, Section of Dermatology, Department of Health Sciences, Azienda USL Toscana Centro, University of Florence, European Reference Network-Skin Member, Florence, Italy
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25
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Boualila L, Mrini B, Tagmouti A, El Moubarik N, Benchekroun Belabbes M, Boutimzine N, Cherkaoui LO. Sinopharm COVID-19 vaccine-induced Stevens-Johnson syndrome. J Fr Ophtalmol 2022; 45:e179-e182. [PMID: 35033375 PMCID: PMC8733279 DOI: 10.1016/j.jfo.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/20/2021] [Accepted: 12/20/2021] [Indexed: 11/24/2022]
Affiliation(s)
- L Boualila
- Department of Ophtalmology A, Ibn-Sina Hospital, University of Med V, Rabat, Morocco.
| | - B Mrini
- Department of Ophtalmology A, Ibn-Sina Hospital, University of Med V, Rabat, Morocco
| | - A Tagmouti
- Department of Ophtalmology A, Ibn-Sina Hospital, University of Med V, Rabat, Morocco
| | - N El Moubarik
- Department of Ophtalmology A, Ibn-Sina Hospital, University of Med V, Rabat, Morocco
| | | | - N Boutimzine
- Department of Ophtalmology A, Ibn-Sina Hospital, University of Med V, Rabat, Morocco
| | - L O Cherkaoui
- Department of Ophtalmology A, Ibn-Sina Hospital, University of Med V, Rabat, Morocco
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26
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Sarangal R, Aulakh S, Arora R, Chopra D. Increased predisposition of sjs ten in COVID-19 patients, presenting as post COVID complication: Report of two cases. Indian Dermatol Online J 2022; 13:237-239. [PMID: 35287406 PMCID: PMC8917493 DOI: 10.4103/idoj.idoj_510_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/18/2021] [Accepted: 09/19/2021] [Indexed: 11/16/2022] Open
Abstract
We report two consecutive cases of toxic epidermal necrolysis presented to our emergency department in the past 5 months. Both patients had history of fever prior to the onset of skin manifestations and showed radiological findings suggestive of COVID-19 pneumonia and elevated D dimers. ALDEN score was used to assess the drug causality, which showed probable and possible associations, respectively. In this report, along with brief review of literature, we highlight the possible role of viral etiology, that is SARS-Cov2, in triggering toxic epidermal necrolysis.
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27
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Oosting SF, van der Veldt AAM, GeurtsvanKessel CH, Fehrmann RSN, van Binnendijk RS, Dingemans AMC, Smit EF, Hiltermann TJN, den Hartog G, Jalving M, Westphal TT, Bhattacharya A, van der Heiden M, Rimmelzwaan GF, Kvistborg P, Blank CU, Koopmans MPG, Huckriede ALW, van Els CACM, Rots NY, van Baarle D, Haanen JBAG, de Vries EGE. mRNA-1273 COVID-19 vaccination in patients receiving chemotherapy, immunotherapy, or chemoimmunotherapy for solid tumours: a prospective, multicentre, non-inferiority trial. Lancet Oncol 2021; 22:1681-1691. [PMID: 34767759 PMCID: PMC8577843 DOI: 10.1016/s1470-2045(21)00574-x] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients with cancer have an increased risk of complications from SARS-CoV-2 infection. Vaccination to prevent COVID-19 is recommended, but data on the immunogenicity and safety of COVID-19 vaccines for patients with solid tumours receiving systemic cancer treatment are scarce. Therefore, we aimed to assess the impact of immunotherapy, chemotherapy, and chemoimmunotherapy on the immunogenicity and safety of the mRNA-1273 (Moderna Biotech, Madrid, Spain) COVID-19 vaccine as part of the Vaccination Against COVID in Cancer (VOICE) trial. METHODS This prospective, multicentre, non-inferiority trial was done across three centres in the Netherlands. Individuals aged 18 years or older with a life expectancy of more than 12 months were enrolled into four cohorts: individuals without cancer (cohort A [control cohort]), and patients with solid tumours, regardless of stage and histology, treated with immunotherapy (cohort B), chemotherapy (cohort C), or chemoimmunotherapy (cohort D). Participants received two mRNA-1273 vaccinations of 100 μg in 0·5 mL intramuscularly, 28 days apart. The primary endpoint, analysed per protocol (excluding patients with a positive baseline sample [>10 binding antibody units (BAU)/mL], indicating previous SARS-CoV-2 infection), was defined as the SARS-CoV-2 spike S1-specific IgG serum antibody response (ie, SARS-CoV-2-binding antibody concentration of >10 BAU/mL) 28 days after the second vaccination. For the primary endpoint analysis, a non-inferiority design with a margin of 10% was used. We also assessed adverse events in all patients who received at least one vaccination, and recorded solicited adverse events in participants who received at least one vaccination but excluding those who already had seroconversion (>10 BAU/mL) at baseline. This study is ongoing and is registered with ClinicalTrials.gov, NCT04715438. FINDINGS Between Feb 17 and March 12, 2021, 791 participants were enrolled and followed up for a median of 122 days (IQR 118 to 128). A SARS-CoV-2-binding antibody response was found in 240 (100%; 95% CI 98 to 100) of 240 evaluable participants in cohort A, 130 (99%; 96 to >99) of 131 evaluable patients in cohort B, 223 (97%; 94 to 99) of 229 evaluable patients in cohort C, and 143 (100%; 97 to 100) of 143 evaluable patients in cohort D. The SARS-CoV-2-binding antibody response in each patient cohort was non-inferior compared with cohort A. No new safety signals were observed. Grade 3 or worse serious adverse events occurred in no participants in cohort A, three (2%) of 137 patients in cohort B, six (2%) of 244 patients in cohort C, and one (1%) of 163 patients in cohort D, with four events (two of fever, and one each of diarrhoea and febrile neutropenia) potentially related to the vaccination. There were no vaccine-related deaths. INTERPRETATION Most patients with cancer develop, while receiving chemotherapy, immunotherapy, or both for a solid tumour, an adequate antibody response to vaccination with the mRNA-1273 COVID-19 vaccine. The vaccine is also safe in these patients. The minority of patients with an inadequate response after two vaccinations might benefit from a third vaccination. FUNDING ZonMw, The Netherlands Organisation for Health Research and Development.
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Affiliation(s)
- Sjoukje F Oosting
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Astrid A M van der Veldt
- Department of Medical Oncology, Erasmus Medical Centre, Rotterdam, Netherlands; Department of Radiology and Nuclear Medicine, Erasmus Medical Centre, Rotterdam, Netherlands.
| | | | - Rudolf S N Fehrmann
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Rob S van Binnendijk
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | | | - Egbert F Smit
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - T Jeroen N Hiltermann
- Department of Pulmonary Diseases, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Gerco den Hartog
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Mathilda Jalving
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | | | - Arkajyoti Bhattacharya
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Marieke van der Heiden
- Department of Medical Microbiology and Infection Prevention, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Guus F Rimmelzwaan
- Research Centre for Emerging Infections and Zoonoses, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Pia Kvistborg
- Department of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Christian U Blank
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Anke L W Huckriede
- Department of Medical Microbiology and Infection Prevention, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Cecile A C M van Els
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands; Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Nynke Y Rots
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Debbie van Baarle
- Department of Medical Microbiology and Infection Prevention, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands; Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - John B A G Haanen
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
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28
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Koutlas IG, Camara R, Argyris PP, Davis MDP, Miller DD. Development of pemphigus vulgaris after the second dose of the mRNA-1273 SARS-Cov-2 vaccine. Oral Dis 2021; 28 Suppl 2:2612-2613. [PMID: 34825752 DOI: 10.1111/odi.14089] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/23/2021] [Indexed: 12/19/2022]
Affiliation(s)
- Ioannis G Koutlas
- Division of Oral and Maxillofacial Pathology, School of Dentistry, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Prokopios P Argyris
- Division of Oral and Maxillofacial Pathology, School of Dentistry, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, Minnesota, USA.,Howard Hughes Medical Institute, University of Minnesota, Minneapolis, Minnesota, USA.,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Daniel D Miller
- Department of Dermatology, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
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29
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Mansouri P, Chalangari R, Martits‐Chalangari K, Mozafari N. Stevens-Johnson Syndrome due to COVID-19 vaccination. Clin Case Rep 2021; 9:e05099. [PMID: 34815881 PMCID: PMC8593881 DOI: 10.1002/ccr3.5099] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 01/01/2023] Open
Abstract
As public COVID-19 vaccination programs are being implemented, it is possible that more rare and serious adverse effects such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrosis (TEN) may occur.
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Affiliation(s)
- Parvin Mansouri
- Skin and Stem Cell Research CenterTehran University of Medical ScienceTehranIran
- Medical Laser Research CentersAcademic Center for Education, Culture and ResearchTehran University of Medical SciencesTehranIran
| | | | | | - Nikoo Mozafari
- Skin Research CenterShahid Beheshti University of Medical SciencesTehranIran
- Department of DermatologyLoghman Hakim HospitalShahid Beheshti University of Medical SciencesTehranIran
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30
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BNT-162b1. REACTIONS WEEKLY 2021. [PMCID: PMC8532432 DOI: 10.1007/s40278-021-04095-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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31
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Bakir M, Almeshal H, Alturki R, Obaid S, Almazroo A. Toxic Epidermal Necrolysis Post COVID-19 Vaccination - First Reported Case. Cureus 2021; 13:e17215. [PMID: 34540442 PMCID: PMC8442571 DOI: 10.7759/cureus.17215] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2021] [Indexed: 01/26/2023] Open
Abstract
Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a spectrum of acute, delayed-type hypersensitivity reactions that affect the skin and the mucous membranes. Medications are the culprit cause of these disorders in addition to infections and in very rare instances vaccinations. We report a case of TEN in a 49-year-old woman with no previous medical history. The disorder developed one week after receiving the first dose of COVID-19 vaccine with no other identifiable causes. The patient received two doses of tumor necrosis factor-alpha inhibitor (etanercept) and she stopped developing new lesions after two days of the initial dose; complete healing was observed after 22 days and no side effects were observed in our patient. This case demonstrates an extremely rare complication to the COVID-19 vaccine. The benefits of receiving the COVID-19 outweigh the potential risk.
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Affiliation(s)
- Mohamad Bakir
- Department of Medicine and Surgery, College of Medicine, Alfaisal University, Riyadh, SAU
| | - Hanan Almeshal
- Department of Dermatology, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, SAU
| | - Rifah Alturki
- Department of Dermatology, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, SAU
| | - Sulaiman Obaid
- Department of Dermatology, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, SAU
| | - Areej Almazroo
- Department of Dermatology, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, SAU
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