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Morais HGDF, Costa CSDO, Medeiros MRDS, Carlan LM, Gonzaga AKG, Freitas RDA, da Silveira ÉJD, de Oliveira PT. Pemphigus vulgaris and mucous membrane pemphigoid: A systematic review of clinical manifestations, diagnosis, and treatment. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101960. [PMID: 38960026 DOI: 10.1016/j.jormas.2024.101960] [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: 04/02/2024] [Revised: 06/08/2024] [Accepted: 06/30/2024] [Indexed: 07/05/2024]
Abstract
Pemphigus vulgaris (PV) and mucous membrane pemphigoid (MMP) are mucocutaneous autoimmune diseases characterized by blistering lesions of mucous membranes and skin, with very similar clinical manifestations. This study aimed to systematically review the literature on the clinical and demographic profile, diagnostic methods, and treatment of patients with pemphigus vulgaris (PV) and mucous membrane pemphigoid (MMP). Studies describing cases of PV and MMP diagnosed by direct immunofluorescence that exhibited intraoral manifestations were included. Thirty-two articles were included, with 18 studies on PV and 15 on MMP, corresponding to 50 and 123 cases diagnosed as PV and MMP, respectively. Most patients with PV (64 %) and MMP (81.3 %) were women in the fifth and sixth decade of life, respectively. The mouth was the primary site of involvement both in PV (71.4 %) and in MMP (91 %). The cheek mucosa and gingiva were the most frequently affected intraoral sites in PV (30 %) and MMP (64.2 %), respectively. Direct immunofluorescence was positive for IgG in all cases of the two conditions. The treatment of choice was systemic corticosteroid therapy for patients with PV (50 %) and topical treatment for patients with MMP (53.7 %). Differences in intraoral site predilection, extraoral involvement, and the results of diagnostic tests allow us to trace the clinical, demographic, and diagnostic profile of PV and MMP that contributes to differential diagnosis and therapeutic management.
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Wu PC, Huang IH, Wang CY, Chi CC. New Onset and Exacerbation of Autoimmune Bullous Dermatosis Following COVID-19 Vaccination: A Systematic Review. Vaccines (Basel) 2024; 12:465. [PMID: 38793716 PMCID: PMC11125893 DOI: 10.3390/vaccines12050465] [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: 03/04/2024] [Revised: 04/14/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Cases of autoimmune bullous dermatosis (AIBD) have been reported following COVID-19 vaccination. OBJECTIVE We aimed to provide an overview of clinical characteristics, treatments, and outcomes of AIBDs following COVID-19 vaccination. METHODS We conducted a systematic review and searched the Embase, Cochrane Library, and Medline databases from their inception to 27 March 2024. We included all studies reporting ≥ 1 patient who developed new-onset AIBD or experienced flare of AIBD following at least one dose of any COVID-19 vaccine. RESULTS We included 98 studies with 229 patients in the new-onset group and 216 in the flare group. Among the new-onset cases, bullous pemphigoid (BP) was the most frequently reported subtype. Notably, mRNA vaccines were commonly associated with the development of AIBD. Regarding the flare group, pemphigus was the most frequently reported subtype, with the mRNA vaccines being the predominant vaccine type. The onset of AIBD ranged from 1 to 123 days post-vaccination, with most patients displaying favorable outcomes and showing improvement or resolution from 1 week to 8 months after treatment initiation. CONCLUSIONS Both new-onset AIBD and exacerbation of pre-existing AIBD may occur following COVID-19 vaccination. Healthcare practitioners should be alert, and post-vaccination monitoring may be essential.
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Affiliation(s)
- Po-Chien Wu
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan 33305, Taiwan; (P.-C.W.); (I.-H.H.)
| | - I-Hsin Huang
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan 33305, Taiwan; (P.-C.W.); (I.-H.H.)
| | - Ching-Ya Wang
- Department of Dermatology, Heping Fuyou Branches, Taipei City Hospital Renai, Taipei 10629, Taiwan;
| | - Ching-Chi Chi
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan 33305, Taiwan; (P.-C.W.); (I.-H.H.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
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Ligrone L, Lembo S, Cillo F, Spennato S, Fabbrocini G, Raimondo A. A severe relapse of pemphigus vulgaris after SARS-CoV-2 vaccination. J Eur Acad Dermatol Venereol 2023; 37:e1369-e1371. [PMID: 37561928 DOI: 10.1111/jdv.19414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023]
Affiliation(s)
- L Ligrone
- Dermatologic Unit, Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - S Lembo
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana' University of Salerno, Salerno, Italy
| | - F Cillo
- Dermatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - S Spennato
- Dermatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - G Fabbrocini
- Dermatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - A Raimondo
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana' University of Salerno, Salerno, Italy
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Hodifa Y, Khalayli N, Hodaifa A, Kudsi M. Remitting seronegative symmetrical synovitis with pitting edema syndrome postsecond COVID-19 vaccination: a case report. Ann Med Surg (Lond) 2023; 85:4118-4120. [PMID: 37554915 PMCID: PMC10406070 DOI: 10.1097/ms9.0000000000001015] [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: 05/15/2023] [Accepted: 06/10/2023] [Indexed: 08/10/2023] Open
Abstract
UNLABELLED Coronavirus disease 19 (COVID-19) has become the most serious public health crisis of our generation, and vaccines are effective in preventing its infection. Remitting seronegative symmetrical synovitis with pitting edema is an idiopathic rare benign syndrome, but it could be secondary to aautoimmune diseases. Here, the authors reported the first case of this syndrome's development after COVID-19 vaccination. CASE PRESENTATION A 52-year-old woman presented with hand edema, arthralgia, and morning stiffness, after receiving the second dose of m RNA COVID-19 vaccination. Examination revealed edema in the dorsum of both hands and symmetrical tenderness of the shoulders, elbows, wrists, knees, and ankles. Blood test results were normal except for elevated levels of C-reactive protein. The immune profile and the tuberculin test were also negative. A hand radiograph showed soft tissue edema. Ultrasonography of the extremities has shown tenosynovitis. Remitting seronegative symmetrical synovitis with pitting edema syndrome was diagnosed according to the diagnostic criteria. She was treated with 30 mg/day prednisolone, with a complete disappearance of edema and arthralgia after 10 days, and the C-reactive protein level was decreased. CLINICAL DISCUSSION Vaccines are still the most effective and protective method against COVID-19 infection, but it may trigger an immunological response. Remitting seronegative symmetrical synovitis with pitting edema (or sometimes RS 3 PE) is a rare nonunderstood syndrome identified by symmetric polyarthritis, synovitis, acute pitting edema of hands and/or feet, and a negative serum rheumatoid factor, with an excellent prognosis to treatment with steroid. Usually occurred in the old aged population, young patients' cases were mentioned. As the authors did not find any data about our subject, this is the first case of this syndrome development after the second dose of COVID-19 vaccination. CONCLUSION The occurrence of acute symmetrical seronegative polysynovitis with extremities edema, in the elderly, should guide toward the diagnosis of this syndrome.
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Affiliation(s)
| | | | | | - Maysoun Kudsi
- Rheumatology, Faculty of Medicine, Damascus University, Damascus, Syria Arab Republic
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Khalayli N, Omar A, Kudsi M. Pemphigus vulgaris after the second dose of COVID-19 vaccination: a case report. J Med Case Rep 2023; 17:322. [PMID: 37496035 PMCID: PMC10373272 DOI: 10.1186/s13256-023-04055-0] [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: 02/18/2023] [Accepted: 06/23/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND As many people worldwide have been vaccinated, more triggered autoimmune bullous diseases have been noticed. We reported a case of new-onset pemphigus Vulgaris after COVID-19 vaccinations. CASE PRESENTATION A 50 years old Syrian female presented with multiple erosions on her extremities, in addition to oral erosions and genital ulcers, after the 2nd dose of the mRNA COVID-19 vaccine. The lesions were multiple tenders and well-defined, reddish erythematous oral ulcers. At the same time the Skin examination showed hyper-pigmented patches over the extremities, a sequel of ruptured bullae. Pemphigus Vulgaris was diagnosed by histology. She continued on 35 mg/day of prednisone for another 2 weeks. CONCLUSIONS Pemphigus is not a contraindication to vaccination, although it may be worse or present as a first onset.
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Affiliation(s)
- Naram Khalayli
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Abdullah Omar
- Faculty of Medicine, Syrian Private University, Damascus, Syria.
- Department of Dermatology and Venerology, Damascus hospital, Damascus, Syria.
| | - Mayssoun Kudsi
- Faculty of Medicine, Syrian Private University, Damascus, Syria
- Rheumatology Department, Damascus University, Damascus, Syria
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Pira A, Sinagra JLM, Moro F, Mariotti F, Di Zenzo G. Autoimmune bullous diseases during COVID-19 pandemic: 2022 update on rituximab and vaccine. Front Med (Lausanne) 2023; 10:1112823. [PMID: 36744126 PMCID: PMC9893122 DOI: 10.3389/fmed.2023.1112823] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023] Open
Abstract
Autoimmune bullous diseases (AIBDs) are a heterogeneous group of life-threatening disorders associated with subepidermal or intraepidermal blistering. Skin barrier alterations and prolonged immunosuppressive treatments increase the risk of infections in patients with AIBDs, who are considered fragile. COVID-19 pandemic had a heavy impact on these patients. Although advances have been made in terms of prevention and treatment of COVID-19, this topic remains significant as the pandemic and its waves could last several years and, so far, a relevant proportion of the population worldwide is not vaccinated. This review is a 2022 update that summarizes and discusses the pandemic's burden on AIBD patients mainly considering relevant studies in terms of: (i) sample dimension; (ii) quality of control populations; (iii) possible standardization by age, gender and country. The findings show that: (i) the risk of COVID-19 infection and its severe course were comparable in AIBD patients and in the general population, except for rituximab-treated patients that presented a higher risk of infection and severe disease; (ii) the mortality rate in COVID-19-infected bullous pemphigoid patients was higher than in the general population, (iii) 121 cases of AIBD onset and 185 cases of relapse or exacerbation occurred after COVID-19 vaccination and a causal relationship has not been demonstrated so far. Altogether, acquired knowledge on COVID-19 pandemic could also be important in possible, albeit undesirable, future pandemic scenarios.
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Affiliation(s)
- Anna Pira
- Molecular and Cell Biology Laboratory, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
| | - Jo Linda Maria Sinagra
- Molecular and Cell Biology Laboratory, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
- Dermatology Unit, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
| | - Francesco Moro
- Molecular and Cell Biology Laboratory, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
- Dermatology Unit, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
| | - Feliciana Mariotti
- Molecular and Cell Biology Laboratory, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
| | - Giovanni Di Zenzo
- Molecular and Cell Biology Laboratory, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
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A Systematic Review of Histopathologic Surveys on Mucocutaneous Biopsies in Patients Developed COVID-19 Vaccine-Related Dermatologic Manifestations. Am J Dermatopathol 2023; 45:1-27. [PMID: 36484603 DOI: 10.1097/dad.0000000000002320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
ABSTRACT Coronavirus 2 is an infectious agent primarily identified as the cause of a pandemic viral pneumonia. With the mass vaccination against this virus, one of the health issues is the safety of currently available vaccines considering their adverse reactions. This systematic review was conducted to assess and summarize all reported data on histopathologic findings associated with mucocutaneous reactions that developed after COVID-19 vaccination for a better pathophysiology interpretation and clinical management of these reactions. A systematic search was performed in PubMed, Web of Science, and Scopus databases as well as Google Scholar engine for relevant English articles published till July 1, 2022. This review includes 131 studies with a total number of 287 cases. Eruptions that underwent a biopsy were mostly described as erythematous maculopapular, papulosquamous, vasculitis-like, lichenoid, or urticarial lesions. Histopathology revealed spongiosis, interstitial, and perivascular lymphohistiocytic infiltration, erythrocyte extravasation, parakeratosis, endothelial inflammation, and the like. Findings were highly consistent with morbilliform erythema, psoriasiform dermatosis, leukocytoclastic vasculitis, and lichenoid or urticarial drug reactions. The majority of these reactions had a mild nature and were primarily observed in patients with underlying health conditions. Microscopic evaluation was also consistent with transient inflammatory changes, and features like neutrophilic infiltrates, subcorneal pustules, and vasculopathy were less frequently reported than what seen in COVID infection. Therefore, dermatologic reactions developing after vaccination in the general population should not hinder a complete vaccination.
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Martora F, Battista T, Nappa P, Fabbrocini G, Megna M. Pemphigus vulgaris and COVID-19 vaccination: Management and treatment. J Cosmet Dermatol 2022; 22:30-31. [PMID: 36083710 PMCID: PMC9538712 DOI: 10.1111/jocd.15374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 09/07/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Fabrizio Martora
- Dermatology Unit, Department of Clinical Medicine and SurgeryUniversity of Naples Federico IINaplesItaly
| | - Teresa Battista
- Dermatology Unit, Department of Clinical Medicine and SurgeryUniversity of Naples Federico IINaplesItaly
| | - Paola Nappa
- Dermatology Unit, Department of Clinical Medicine and SurgeryUniversity of Naples Federico IINaplesItaly
| | - Gabriella Fabbrocini
- Dermatology Unit, Department of Clinical Medicine and SurgeryUniversity of Naples Federico IINaplesItaly
| | - Matteo Megna
- Dermatology Unit, Department of Clinical Medicine and SurgeryUniversity of Naples Federico IINaplesItaly
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Almasi‐Nasrabadi M, Ayyalaraju RS, Sharma A, Elsheikh S, Ayob S. New onset pemphigus foliaceus following AstraZeneca COVID-19 vaccination. J Eur Acad Dermatol Venereol 2022; 37:e1-e3. [PMID: 35964302 PMCID: PMC9539208 DOI: 10.1111/jdv.18484] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/05/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Mina Almasi‐Nasrabadi
- Department of DermatologyNottingham University Hospitals NHS Trust, Treatment CentreNottinghamUK
| | - Radha S. Ayyalaraju
- Department of DermatologyNottingham University Hospitals NHS Trust, Treatment CentreNottinghamUK
| | - Ashish Sharma
- Department of DermatologyNottingham University Hospitals NHS Trust, Treatment CentreNottinghamUK
| | - Somaia Elsheikh
- Department of HistopathologyNottingham University Hospitals NHS Trust, QMC CampusNottinghamUK
| | - Shanti Ayob
- Department of DermatologyNottingham University Hospitals NHS Trust, Treatment CentreNottinghamUK
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Pemphigus during the COVID-19 Epidemic: Infection Risk, Vaccine Responses and Management Strategies. J Clin Med 2022; 11:jcm11143968. [PMID: 35887732 PMCID: PMC9317200 DOI: 10.3390/jcm11143968] [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: 05/19/2022] [Revised: 06/23/2022] [Accepted: 07/06/2022] [Indexed: 01/08/2023] Open
Abstract
Pemphigus is a rare autoimmune blistering disease, involving potentially life-threatening conditions often requiring immunosuppression. Currently, the COVID-19 pandemic caused by severe acute respiratory disease coronavirus 2 (SARS-CoV-2) infection has become a global public emergency. Vaccines are the most effective defense against COVID-19 infection. However, in clinic, there are cases of new onset or flare of pemphigus following COVID-19 vaccination, where vaccines have manifested significantly desirable risk-benefit profiles for patients. Although Rituximab, as first-line therapy, may impair humoral immunity, pemphigus may not predispose to develop COVID-19 infection compared to a healthy population. Conversely, delay or interruption of immunosuppressants probably results in unfavorable clinical outcomes for disease progression. Overall, clinicians should encourage their patients to undergo the vaccination after a comprehensive assessment. The definite association between COVID-19 vaccination and pemphigus remains to be further elucidated. Herein, we provide an overview of the published studies to date on COVID-19 and pemphigus as well as the exploration of their complicated interplay. In addition, we discuss the management strategies for pemphigus patients in this special period, in an effort to more effectively establish a standard treatment paradigm for this particular patient group.
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COVID-19-vaccine/SARS-COV-2-vaccine-inactivated-Sinovac-Biotech/tozinameran. REACTIONS WEEKLY 2022. [PMCID: PMC9163912 DOI: 10.1007/s40278-022-16487-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Calabria E, Canfora F, Mascolo M, Varricchio S, Mignogna MD, Adamo D. Autoimmune mucocutaneous blistering diseases after SARS-Cov-2 vaccination: A Case report of Pemphigus Vulgaris and a literature review. Pathol Res Pract 2022; 232:153834. [PMID: 35278817 PMCID: PMC8896864 DOI: 10.1016/j.prp.2022.153834] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cases of severe autoimmune blistering diseases (AIBDs) have recently been reported in association with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. AIMS To describe a report of oropharyngeal Pemphigus Vulgaris (OPV) triggered by the mRNABNT162b2 vaccine (Comirnaty®/ Pfizer/ BioNTech) and to analyze the clinical and immunological characteristics of the AIBDs cases reported following the SARS-CoV-2 vaccination. METHODS The clinical and immunological features of our case of OPV were documented. A review of the literature was conducted and only cases of AIBDs arising after the SARS-CoV-2 vaccination were included. CASE REPORT A 60-year old female patients developed oropharyngeal and nasal bullous lesions seven days after the administration of a second dose of the mRNABNT162b2 vaccine (Comirnaty®/ Pfizer/BioNtech). According to the histology and direct immunofluorescence findings showing the presence of supra-basal blister and intercellular staining of IgG antibodies and the presence of a high level of anti-Dsg-3 antibodies (80 U/ml; normal < 7 U/ml) in the serum of the patients, a diagnosis of oropharyngeal Pemphigus Vulgaris was made. REVIEW A total of 35 AIBDs cases triggered by the SARS-CoV-2 vaccination were found (including our report). 26 (74.3%) were diagnosed as Bullous Pemphigoid, 2 (5.7%) as Linear IgA Bullous Dermatosis, 6 (17.1%) as Pemphigus Vulgaris and 1 (2.9%) as Pemphigus Foliaceus. The mean age of the sample was 72.8 years and there was a predominance of males over females (F:M=1:1.7). In 22 (62.9%) cases, the disease developed after Pfizer vaccine administration, 6 (17.1%) after Moderna, 3 (8.6%) after AstraZeneca, 3 (8.6%) after CoronaVac (one was not specified). All patients were treated with topical and/or systemic corticosteroids, with or without the addition of immunosuppressive drugs, with a good clinical response in every case. CONCLUSION Clinicians should be aware of the potential, though rare, occurrence of AIBDs as a possible adverse event after the SARS-CoV-2 vaccination. However, notwithstanding, they should encourage their patients to obtain the vaccination in order to assist the public health systems to overcome the COVID-19 pandemic.
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Affiliation(s)
- Elena Calabria
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, via Pansini 5, 80131 Naples, Italy
| | - Federica Canfora
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, via Pansini 5, 80131 Naples, Italy.
| | - Massimo Mascolo
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Silvia Varricchio
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Michele Davide Mignogna
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, via Pansini 5, 80131 Naples, Italy
| | - Daniela Adamo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, via Pansini 5, 80131 Naples, Italy
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