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Souza EN, Diniz LM, Moura LAD, Oliosi AC. Exacerbation of Chronic Cutaneous Lupus Erythematosus Triggered by Vaccine Against COVID-19. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:430-432. [PMID: 36511288 PMCID: PMC9729933 DOI: 10.1016/j.ad.2022.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 07/21/2022] [Accepted: 08/08/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- E N Souza
- Universidade Federal do Espirito Santo (UFES), Vitória, ES, Brazil; Hospital Universitário Cassiano Antônio Moraes (HUCAM), Vitória, ES, Brazil.
| | - L M Diniz
- Universidade Federal do Espirito Santo (UFES), Vitória, ES, Brazil
| | - L A D Moura
- Universidade Federal do Espirito Santo (UFES), Vitória, ES, Brazil; Hospital Universitário Cassiano Antônio Moraes (HUCAM), Vitória, ES, Brazil
| | - A C Oliosi
- Universidade Federal do Espirito Santo (UFES), Vitória, ES, Brazil; Hospital Universitário Cassiano Antônio Moraes (HUCAM), Vitória, ES, Brazil
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2
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Souza EN, Diniz LM, Moura LAD, Oliosi AC. Exacerbation of Chronic Cutaneous Lupus Erythematosus Triggered by Vaccine Against COVID-19. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T430-T432. [PMID: 38325543 DOI: 10.1016/j.ad.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/08/2022] [Indexed: 02/09/2024] Open
Affiliation(s)
- E N Souza
- Universidade Federal do Espirito Santo (UFES), Vitória, ES, Brasil; Hospital Universitário Cassiano Antônio Moraes (HUCAM), Vitória, ES, Brasil.
| | - L M Diniz
- Universidade Federal do Espirito Santo (UFES), Vitória, ES, Brasil
| | - L A D Moura
- Universidade Federal do Espirito Santo (UFES), Vitória, ES, Brasil; Hospital Universitário Cassiano Antônio Moraes (HUCAM), Vitória, ES, Brasil
| | - A C Oliosi
- Universidade Federal do Espirito Santo (UFES), Vitória, ES, Brasil; Hospital Universitário Cassiano Antônio Moraes (HUCAM), Vitória, ES, Brasil
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3
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Moriyama M, Noda K, Ito H, Matsushita T, Kurosaka D. Clinical features of newly diagnosed systemic lupus erythematosus after SARS-CoV-2 vaccination. Mod Rheumatol Case Rep 2023; 8:63-68. [PMID: 37348045 DOI: 10.1093/mrcr/rxad036] [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: 04/21/2023] [Revised: 06/05/2023] [Accepted: 06/13/2023] [Indexed: 06/24/2023]
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease that causes damage to multiple organs. Various factors, including vaccination, have been associated with SLE development. Vaccination for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began in 2020, and there are a few reports on the exacerbation of SLE after SARS-CoV-2 vaccination. The influence of SARS-CoV-2 vaccination on SLE development remains unclear. We present the case of a 53-year-old man who developed peritonitis and was subsequently diagnosed with SLE on Day 9 after receiving a third dose of the messenger ribonucleic acid-1273 SARS-CoV-2 vaccine. This case and previous reports have shown that patients who developed SLE after SARS-CoV-2 vaccination are more likely to develop it within 2 weeks of vaccination, especially when they have a higher rate of immunological abnormalities or a family history of autoimmune diseases. Furthermore, these features suggest that type I interferon is involved in the pathogenesis of SLE after SARS-CoV-2 vaccination.
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Affiliation(s)
- Masayori Moriyama
- Division of Rheumatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Kentaro Noda
- Division of Rheumatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Haruyasu Ito
- Division of Rheumatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Takayuki Matsushita
- Division of Rheumatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Daitaro Kurosaka
- Division of Rheumatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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4
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González-Meléndez A, Báez-Negrón L, Ríos-Rivera R, Franco-O'Connell AS, Nieves-Plaza M, Vilá LM. Short- and mid-term outcomes in systemic lupus erythematosus patients presenting with disease exacerbation after SARS-CoV-2 mRNA vaccination: A cohort study from Puerto Rico. Lupus 2023; 32:571-579. [PMID: 36639887 DOI: 10.1177/09612033231151898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To determine if SARS-CoV-2 mRNA vaccination has an impact on the clinical course of systemic lupus erythematosus (SLE). METHODS Puerto Ricans with SLE who received mRNA COVID-19 vaccines were studied. Demographic parameters, clinical manifestations, disease activity (per Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), disease damage (per Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index), emergency room visits, hospitalizations, and pharmacologic therapy were determined. Baseline variables (prior to vaccination) were compared between patients with and without exacerbation after SARS-CoV-2 vaccination. Among those with exacerbation, clinical outcomes were determined up to 1 year after vaccination. RESULTS Of the entire cohort (n = 247), 14 (5.7%) had post-vaccination exacerbations. Photosensitivity, oral ulcers, anti-Ro antibodies, higher SLEDAI score, and corticosteroids exposure were associated with post-vaccination flares. Among those with post-vaccination flares, 10 (71.4%) had major organ involvement. No significant differences were observed for mean SLEDAI scores, emergency room visits, hospitalizations, disease damage, and exposure to immunosuppressive drugs before and after SARS-CoV-2 mRNA vaccination. At 12 months of follow-up, all patients were fully controlled without evidence of active disease. CONCLUSION In our group of SLE patients, 5.7% had a disease flare after SARS-CoV-2 mRNA vaccination. Most had exacerbations involving major organs/systems. Mucocutaneous manifestations, anti-Ro antibodies, disease activity, and corticosteroids were associated with flares. Awareness of these factors and the possibility of a major lupus flare after vaccination with COVD-19 vaccines is critical to provide timely and effective therapy.
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Affiliation(s)
- Ariana González-Meléndez
- Division of Rheumatology, Department of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Laisha Báez-Negrón
- Division of Rheumatology, Department of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Rafael Ríos-Rivera
- Division of Rheumatology, Department of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Alexandra S Franco-O'Connell
- Division of Rheumatology, Department of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | | | - Luis M Vilá
- Division of Rheumatology, Department of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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5
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Nelson MC, Rytting H, Greenbaum LA, Goldberg B. Presentation of SLE after COVID vaccination in a pediatric patient. BMC Rheumatol 2022; 6:81. [PMID: 36536389 PMCID: PMC9762983 DOI: 10.1186/s41927-022-00313-8] [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: 06/16/2022] [Accepted: 10/05/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The outbreak of severe acute respiratory syndrome coronavirus 2 has had an enormous impact on global health. Vaccination remains one of the most effective interventions for disease prevention. Clinically significant vaccine side effects are uncommon, though autoimmune-mediated disease occurs in a small percentage of vaccine recipients. Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that is associated with significant morbidity and mortality. Childhood-onset SLE tends to have more severe disease manifestations than adult-onset SLE. In adults, there are a few reported cases of SLE developing soon after coronavirus disease 2019 (COVID-19) mRNA vaccination. CASE PRESENTATION A 14-year-old previously healthy male developed laboratory and clinical evidence of SLE, including maculopapular malar rash, arthritis, pleuritic chest pain, and class V (membranous) lupus nephritis, 2 days after his third dose of the Pfizer-BioNTech COVID-19 vaccine. The patient's symptoms improved after initiation of prednisone and mycophenolate mofetil. We also summarize eleven prior case reports describing SLE after COVID-19 vaccine in adults. CONCLUSION To our knowledge, this is the first reported pediatric patient with new onset SLE following COVID-19 mRNA vaccination. While potential mechanistic links exist between COVID-19 vaccination and SLE development, additional studies are necessary to elucidate the exact nature of this relationship.
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Affiliation(s)
- Meghan Corrigan Nelson
- grid.189967.80000 0001 0941 6502Division of Pediatric Rheumatology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA ,grid.428158.20000 0004 0371 6071Children’s Healthcare of Atlanta, Atlanta, USA
| | - Heather Rytting
- grid.428158.20000 0004 0371 6071Division of Pathology, Children’s Healthcare of Atlanta, Atlanta, USA
| | - Larry A. Greenbaum
- grid.428158.20000 0004 0371 6071Children’s Healthcare of Atlanta, Atlanta, USA ,grid.189967.80000 0001 0941 6502Division of Pediatric Nephrology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA
| | - Baruch Goldberg
- grid.189967.80000 0001 0941 6502Division of Pediatric Rheumatology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA ,grid.428158.20000 0004 0371 6071Children’s Healthcare of Atlanta, Atlanta, USA
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6
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Avcı C, Şirin ND, İlknur T, Lebe B, Akarsu S. Exacerbation of Lupus Erythematosus Panniculitis After Administration of COVID-19 mRNA Vaccine. Indian J Dermatol 2022; 67:825-828. [PMID: 36998883 PMCID: PMC10043697 DOI: 10.4103/ijd.ijd_591_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Affiliation(s)
- Ceylan Avcı
- Department of Dermatology, Dokuz Eylul University, Faculty of Medicine, İzmir, Turkey
| | - Nilüfer Diana Şirin
- Department of Dermatology, Dokuz Eylul University, Faculty of Medicine, İzmir, Turkey
| | - Turna İlknur
- Department of Dermatology, Dokuz Eylul University, Faculty of Medicine, İzmir, Turkey
| | - Banu Lebe
- Department of Pathology, Dokuz Eylul University, Faculty of Medicine, İzmir, Turkey E-mail:
| | - Sevgi Akarsu
- Department of Dermatology, Dokuz Eylul University, Faculty of Medicine, İzmir, Turkey
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7
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Liu JL, Woo JMP, Parks CG, Costenbader KH, Jacobsen S, Bernatsky S. Systemic Lupus Erythematosus Risk: The Role of Environmental Factors. Rheum Dis Clin North Am 2022; 48:827-843. [PMID: 36332998 DOI: 10.1016/j.rdc.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Systemic lupus erythematosus (SLE) is a complex, chronic autoimmune disease. The etiology of SLE is multifactorial and includes potential environmental triggers, which may occur sequentially (the "multi-hit" hypothesis). This review focuses on SLE risk potentially associated with environmental factors including infections, the microbiome, diet, respirable exposures (eg, crystalline silica, smoking, air pollution), organic pollutants, heavy metals, and ultraviolet radiation.
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Affiliation(s)
- Jia Li Liu
- McGill University, Montreal, Quebec, Canada
| | - Jennifer M P Woo
- Epidemiology Branch, Department of Health and Human Services, National Institutes of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - Christine G Parks
- Epidemiology Branch, Department of Health and Human Services, National Institutes of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - Karen H Costenbader
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Søren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Sasha Bernatsky
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
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8
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Bakr F, Denny J, Babakinejad P, Giles A, du Peloux Menagé H. Cutaneous lupus erythematosus flare with vitiligo-like depigmentation following the AstraZeneca COVID vaccine. JAAD Case Rep 2022; 30:51-55. [PMID: 36340858 PMCID: PMC9623502 DOI: 10.1016/j.jdcr.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Farrah Bakr
- Department of Dermatology, University Hospital Lewisham, London, United Kingdom,Correspondence to: Farrah Bakr, MBBS, MRCP, University Hospital Lewisham, Lewisham High St, London SE13 6LH, United Kingdom
| | - James Denny
- Department of Dermatology, University Hospital Lewisham, London, United Kingdom
| | | | - Andrew Giles
- Department of Histopathology, University Hospital Lewisham, London, United Kingdom
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9
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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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10
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Voisin O, Priollet P. Systemic Lupus Induced by Messenger RNA Vaccination. Mayo Clin Proc 2022; 97:1398-1399. [PMID: 35787868 PMCID: PMC9247624 DOI: 10.1016/j.mayocp.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/04/2022] [Indexed: 10/28/2022]
Affiliation(s)
- Olivier Voisin
- Etienne Raphaël, Department of Internal Medicine, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Pascal Priollet
- Department of Vascular Medicine, Groupe Hospitalier Paris Saint-Joseph, Paris, France
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11
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Choi MY, Costenbader KH. Understanding the Concept of Pre-Clinical Autoimmunity: Prediction and Prevention of Systemic Lupus Erythematosus: Identifying Risk Factors and Developing Strategies Against Disease Development. Front Immunol 2022; 13:890522. [PMID: 35720390 PMCID: PMC9203849 DOI: 10.3389/fimmu.2022.890522] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/04/2022] [Indexed: 12/27/2022] Open
Abstract
There is growing evidence that preceding the diagnosis or classification of systemic lupus erythematosus (SLE), patients undergo a preclinical phase of disease where markers of inflammation and autoimmunity are already present. Not surprisingly then, even though SLE management has improved over the years, many patients will already have irreversible disease-related organ damage by time they have been diagnosed with SLE. By gaining a greater understanding of the pathogenesis of preclinical SLE, we can potentially identify patients earlier in the disease course who are at-risk of transitioning to full-blown SLE and implement preventative strategies. In this review, we discuss the current state of knowledge of SLE preclinical pathogenesis and propose a screening and preventative strategy that involves the use of promising biomarkers of early disease, modification of lifestyle and environmental risk factors, and initiation of preventative therapies, as examined in other autoimmune diseases such as rheumatoid arthritis and type 1 diabetes.
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Affiliation(s)
- May Y Choi
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States.,Department of Medicine, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Calgary, AB, Canada
| | - Karen H Costenbader
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
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12
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Washrawirul C, Triwatcharikorn J, Phannajit J, Ullman M, Susantitaphong P, Rerknimitr P. Global prevalence and clinical manifestations of cutaneous adverse reactions following COVID-19 vaccination: A systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2022; 36:1947-1968. [PMID: 35666609 PMCID: PMC9348179 DOI: 10.1111/jdv.18294] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/18/2022] [Indexed: 01/08/2023]
Abstract
Although vaccination is widely accepted as an effective method of preventing and controlling the COVID-19 pandemic, many people are concerned about possible cutaneous side effects which can delay or prevent them from being vaccinated. The objectives of this systematic review were to assess the global prevalence and clinical manifestations of cutaneous adverse reactions following COVID-19 vaccination. PubMed and Scopus databases were searched for articles published from January 1, 2019, to December 31, 2021, and reference lists for each selected article were screened. Case reports, case series, observational studies, and randomized controlled trials that provided information on cutaneous adverse reactions following COVID-19 vaccines were included. A total of 300 studies were included in a systematic review of which 32 studies with 946,366 participants were included in the meta-analysis. The pooled prevalence of cutaneous manifestations following COVID-19 vaccination was 3.8% (95% CI, 2.7%-5.3%). COVID-19 vaccines based on the mRNA platform had a higher prevalence than other platforms at 6.9% (95% CI, 3.8%-12.3%). Various cutaneous manifestations have been reported from injection site reactions which were the most common (72.16%) to uncommon adverse reactions such as delayed inflammatory reactions to tissue filler (0.07%) and flares of pre-existing dermatoses (0.07%). Severe cutaneous reactions such as anaphylaxis have also been reported, but in rare cases (0.05%). In conclusion, cutaneous adverse reactions are common, especially in those receiving mRNA vaccines. Most reactions are mild and are not contraindications to subsequent vaccination except for anaphylaxis, which rarely occurs. COVID-19 vaccination may also be associated with flares of pre-existing dermatoses and delayed inflammatory reactions to tissue filler. Patients with a history of allergies, pre-existing skin conditions, or scheduled for filler injections should receive additional pre-counseling and monitoring. A better understanding of potential side effects may strengthen public confidence in those wary of new vaccine technologies.
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Affiliation(s)
- C Washrawirul
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - J Triwatcharikorn
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - J Phannajit
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Division of Clinical Epidemiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Research Unit for Metabolic Bone Disease in CKD Patients, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - M Ullman
- Department of Research Affairs, Chulalongkorn University, Bangkok, Thailand
| | - P Susantitaphong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Research Unit for Metabolic Bone Disease in CKD Patients, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - P Rerknimitr
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Skin and Allergy Research Unit, Chulalongkorn University, Bangkok, Thailand
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13
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Lemoine C, Padilla C, Krampe N, Doerfler S, Morgenlander A, Thiel B, Aggarwal R. Systemic lupus erythematous after Pfizer COVID-19 vaccine: a case report. Clin Rheumatol 2022; 41:1597-1601. [PMID: 35294664 PMCID: PMC8924566 DOI: 10.1007/s10067-022-06126-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 12/20/2022]
Abstract
The Pfizer-BioNTech COVID-19 vaccine has been authorized by the U.S. Food and Drug Administration as it demonstrated 95% effectiveness against the SARS-CoV-2 virus. Although the initial vaccine trials showed a favorable side effect profile, there have been concerns regarding activation of aberrant immune responses, triggering autoimmunity. This is a case report of a 68-year-old woman without history of autoimmune conditions, who presented to our emergency department 7 days after receiving the Pfizer-BioNTech COVID-19 vaccine. Her initial symptoms were suggestive of polymyalgia rheumatica, and she had nearly complete response to steroids. Interestingly, she later met criteria for classified systemic lupus erythematous given the development of inflammatory arthritis, positive ANA, and positive dsDNA. The temporal relationship of her symptoms that started 2 days after vaccine administration could suggest a possible association between the Pfizer-BioNTech COVID-19 and the development of systemic lupus erythematous.
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Affiliation(s)
- Chantal Lemoine
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Cristina Padilla
- Department of Rheumatology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Noah Krampe
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sean Doerfler
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Adam Morgenlander
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Brent Thiel
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Rohit Aggarwal
- Department of Rheumatology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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14
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Avallone G, Quaglino P, Cavallo F, Roccuzzo G, Ribero S, Zalaudek I, Conforti C. SARS-CoV-2 vaccine-related cutaneous manifestations: a systematic review. Int J Dermatol 2022; 61:1187-1204. [PMID: 35141881 PMCID: PMC9111829 DOI: 10.1111/ijd.16063] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 12/10/2021] [Accepted: 12/30/2021] [Indexed: 12/14/2022]
Abstract
To date, over 250 million people have been reportedly infected by COVID‐19 disease, which has spread across the globe and led to approximately 5.1 million fatalities. To prevent both COVID‐19 and viral transmission, DNA‐based/RNA‐based vaccines, non‐replicating viral vector vaccines, and inactivated vaccines have been recently developed. However, a precise clinical and histological characterization of SARS‐CoV‐2 vaccine‐related dermatological manifestations is still lacking. A systematic review of 229 articles was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines, in order to provide an extensive overview of SARS‐CoV‐2 vaccine‐related skin manifestations. Data on demographics, number of reported cases with cutaneous involvement, vaccine, and rash type (morphology) were extracted from articles and summarized. A total of 5941 SARS‐CoV‐2 vaccine‐related dermatological manifestations were gathered. Local injection‐site reactions were the most frequently observed, followed by rash/unspecified cutaneous eruption, urticarial rashes, angioedema, herpes zoster, morbilliform/maculopapular/erythematous macular eruption, pityriasis rosea and pityriasis rosea‐like eruptions, and other less common dermatological manifestations. Flares of pre‐existing dermatological conditions were also reported. Cutaneous adverse reactions following SARS‐CoV‐2 vaccine administration seem to be heterogeneous, rather infrequent, and not life‐threatening. Vaccinated patients should be monitored for skin manifestations, and dermatological evaluation should be offered, when needed.
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Affiliation(s)
- Gianluca Avallone
- Dermatology Clinic, Department of Medical Sciences University of Turin, Turin, Italy
| | - Pietro Quaglino
- Dermatology Clinic, Department of Medical Sciences University of Turin, Turin, Italy
| | - Francesco Cavallo
- Dermatology Clinic, Department of Medical Sciences University of Turin, Turin, Italy
| | - Gabriele Roccuzzo
- Dermatology Clinic, Department of Medical Sciences University of Turin, Turin, Italy
| | - Simone Ribero
- Dermatology Clinic, Department of Medical Sciences University of Turin, Turin, Italy
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy
| | - Claudio Conforti
- Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy
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15
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AZD-1222. REACTIONS WEEKLY 2022. [PMCID: PMC8777440 DOI: 10.1007/s40278-022-09064-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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16
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Chen Y, Xu Z, Wang P, Li XM, Shuai ZW, Ye DQ, Pan HF. New-onset autoimmune phenomena post COVID-19 vaccination. Immunology 2021; 165:386-401. [PMID: 34957554 DOI: 10.1111/imm.13443] [Citation(s) in RCA: 249] [Impact Index Per Article: 83.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/28/2021] [Accepted: 12/22/2021] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to an unprecedented setback for global economy and health. Vaccination is one of the most effective intervention to substantially reduce severe disease and death due to SARS-CoV-2 infection. Vaccination programs are being rolled out globally, but most of these vaccines have been approved without extensive studies on their side effects and efficacy. Recently, new-onset autoimmune phenomena after COVID-19 vaccination have been reported increasingly (e.g., immune thrombotic thrombocytopenia, autoimmune liver diseases, Guillain-Barré syndrome, IgA nephropathy, rheumatoid arthritis and systemic lupus erythematosus, etc.). Molecular mimicry, the production of particular autoantibodies and the role of certain vaccine adjuvants seem to be substantial contributors to autoimmune phenomena. However, whether the association between COVID-19 vaccine and autoimmune manifestations is coincidental or causal remains to be elucidated. Here, we summarize the emerging evidence about autoimmune manifestations occurring in response to certain COVID-19 vaccines. Although information pertaining to the risk of autoimmune disease as a consequence of vaccination is controversial, we merely propose our current understanding of autoimmune manifestations associated with COVID-19 vaccine. In fact, we do not aim to disavow the overwhelming benefits of mass COVID-19 vaccination in preventing COVID-19 morbidity and mortality. These reports could help guide clinical assessment and management of autoimmune manifestations after COVID-19 vaccination.
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Affiliation(s)
- Yue Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, 81 Meishan Road, Hefei, Anhui, 230032, China
| | - Zhiwei Xu
- School of Public Health, Faculty of Medicine, University of Queensland, 288 Herston Road, QLD, 4006, Brisbane, Australia
| | - Peng Wang
- Teaching Center of Preventive Medicine, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China
| | - Xiao-Mei Li
- Department of Rheumatology, the First Affiliated Hospital of University of Science and Technology of China, 17 Lujiang Road, Hefei, Anhui, 230001, China
| | - Zong-Wen Shuai
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230032, China
| | - Dong-Qing Ye
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, 81 Meishan Road, Hefei, Anhui, 230032, China
| | - Hai-Feng Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, 81 Meishan Road, Hefei, Anhui, 230032, China
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17
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Zengarini C, Pileri A, Salamone FP, Piraccini BM, Vitale G, La Placa M. Subacute cutaneous lupus erythematosus induction after SARS-CoV-2 vaccine in a patient with primary biliary cholangitis. J Eur Acad Dermatol Venereol 2021; 36:e179-e180. [PMID: 34807495 PMCID: PMC9011449 DOI: 10.1111/jdv.17827] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/17/2021] [Indexed: 11/30/2022]
Affiliation(s)
- C Zengarini
- Dermatology Unit, IRCCS of Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - A Pileri
- Dermatology Unit, IRCCS of Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - F P Salamone
- Dermatology Unit, IRCCS of Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - B M Piraccini
- Dermatology Unit, IRCCS of Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - G Vitale
- Internal Medicine Unit for the Treatment of Severe Organ Failure Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - M La Placa
- Dermatology Unit, IRCCS of Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
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18
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Cutaneous Adverse Reactions Associated with SARS-CoV-2 Vaccines. J Clin Med 2021; 10:jcm10225344. [PMID: 34830627 PMCID: PMC8618511 DOI: 10.3390/jcm10225344] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/11/2021] [Accepted: 11/13/2021] [Indexed: 12/19/2022] Open
Abstract
Many patients are receiving SARS-CoV-2 vaccinations, which have been associated with a variety of adverse effects. Cutaneous adverse reactions to SARS-CoV-2 vaccinations have been progressively reported, but they have not been reviewed according to their morphological clinical patterns. The objective of this review was to summarize the existing data concerning the cutaneous adverse reactions following SARS-CoV-2 vaccines and group them according to common morphological and pathogenetic patterns. We reviewed the English language literature up to 15 August 2021, using predefined keywords to identify the relevant studies evaluating cutaneous adverse reactions associated with SARS-CoV-2 vaccines. We search for recurrent morphological patterns sharing clinical signs and symptoms and physio-pathological mechanisms. Timing to onset following the first or booster dose of the vaccine, predisposing conditions, therapeutic management, and outcome were also collected. Among the dermatological manifestations associated with SARS-CoV-2 vaccinations, we distinguished: (1) new onset reactions and (2) flares of preexisting dermatoses. The most common were injection site reactions, affecting 30–70% and generally mild or moderate. Small case series or single case reports included filler reactions, exanthemas, vascular lesions, urticaria, eczematous dermatitis, autoimmune bullous reactions, and severe cutaneous adverse reactions. In addition, the exacerbation of chronic immuno-mediated dermatoses (mainly psoriasis and atopic dermatitis) and reactivations of herpes infection were reported. The cutaneous reactions were generally mild, self-limiting, and resembled common cutaneous drug eruptions and/or COVID-19 skin manifestations.
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19
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Lotfi Z, Haghighi A, Akbarzadehpasha A, Mozafarpoor S, Goodarzi A. Pansclerotic Morphea Following COVID-19: A Case Report and Review of Literature on Rheumatologic and Non-rheumatologic Dermatologic Immune-Mediated Disorders Induced by SARS-CoV-2. Front Med (Lausanne) 2021; 8:728411. [PMID: 34746174 PMCID: PMC8564069 DOI: 10.3389/fmed.2021.728411] [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: 06/21/2021] [Accepted: 09/14/2021] [Indexed: 12/12/2022] Open
Abstract
While mucocutaneous manifestations of COVID-19 have been frequently reported and added to our knowledge every day during the pandemic, another issue is the COVID-related diseases that can present as intensified lesions of underlying diseases, a new disease, or changes in the behavior of an old lesion. Given that immune system overreaction and cytokine storm are among the most prominent events in COVID-19, the incidence of autoimmune diseases is expected to increase after COVID-19, as confirmed in several reports. To increase the body of knowledge about short- and long-term outcomes of COVID-19 for specialists, it is essential that similar cases be reported and collected for years to come. The present study investigated a case of pansclerotic morphea that rapidly progressed a few weeks after infection with COVID-19 in a 57-year-old woman with no history of any autoimmune skin or rheumatic diseases. She was prescribed outpatient COVID-19 treatment of azithromycin, vitamins D and C, and then quarantined for 2 weeks. The manifestations of the disease were exacerbated at each follow-up and sampling visit at short intervals. This kind of pansclerotic morphea is reported for the first time.
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Affiliation(s)
- Zahra Lotfi
- Department of Dermatology, Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Dermatology, Rasool Akram Medical Complex, Iran University of Medical Sciences, Tehran, Iran
| | - Anousheh Haghighi
- Department of Rheumatology, Rasool Akram Medical Complex, Iran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Akbarzadehpasha
- Department of Internal Medicine, Rasool Akram Medical Complex, Iran University of Medical Sciences, Tehran, Iran
| | - Samaneh Mozafarpoor
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical Complex, Iran University of Medical Sciences, Tehran, Iran
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20
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Kreuter A, Licciardi-Fernandez MJ, Burmann SN, Burkert B, Oellig F, Michalowitz AL. Induction and exacerbation of subacute cutaneous lupus erythematosus following messenger-RNA or adenoviral-vector based SARS-CoV-2 vaccination. Clin Exp Dermatol 2021; 47:161-163. [PMID: 34291477 PMCID: PMC8444843 DOI: 10.1111/ced.14858] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 12/01/2022]
Affiliation(s)
- A Kreuter
- Department of Dermatology, Venereology and Allergology, HELIOS St. Elisabeth Hospital Oberhausen, University Witten, Herdecke, Germany
| | - M J Licciardi-Fernandez
- Department of Dermatology, Venereology and Allergology, HELIOS St. Elisabeth Hospital Oberhausen, University Witten, Herdecke, Germany
| | - S-N Burmann
- Department of Dermatology, Venereology and Allergology, HELIOS St. Elisabeth Hospital Oberhausen, University Witten, Herdecke, Germany
| | - B Burkert
- Department of Dermatology, Venereology and Allergology, HELIOS St. Elisabeth Hospital Oberhausen, University Witten, Herdecke, Germany
| | - F Oellig
- Institute of Pathology, Mülheim an der Ruhr, Germany
| | - A-L Michalowitz
- Department of Dermatology, Venereology and Allergology, HELIOS St. Elisabeth Hospital Oberhausen, University Witten, Herdecke, Germany
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