1
|
du Preez HN, Lin J, Maguire GEM, Aldous C, Kruger HG. COVID-19 vaccine adverse events: Evaluating the pathophysiology with an emphasis on sulfur metabolism and endotheliopathy. Eur J Clin Invest 2024; 54:e14296. [PMID: 39118373 DOI: 10.1111/eci.14296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 07/24/2024] [Indexed: 08/10/2024]
Abstract
In this narrative review, we assess the pathophysiology of severe adverse events that presented after vaccination with DNA and mRNA vaccines against COVID-19. The focus is on the perspective of an undersulfated and degraded glycocalyx, considering its impact on immunomodulation, inflammatory responses, coagulation and oxidative stress. The paper explores various factors that lead to glutathione and inorganic sulfate depletion and their subsequent effect on glycocalyx sulfation and other metabolites, including hormones. Components of COVID-19 vaccines, such as DNA and mRNA material, spike protein antigen and lipid nanoparticles, are involved in possible cytotoxic effects. The common thread connecting these adverse events is endotheliopathy or glycocalyx degradation, caused by depleted glutathione and inorganic sulfate levels, shear stress from circulating nanoparticles, aggregation and formation of protein coronas; leading to imbalanced immune responses and chronic release of pro-inflammatory cytokines, ultimately resulting in oxidative stress and systemic inflammatory response syndrome. By understanding the underlying pathophysiology of severe adverse events, better treatment options can be explored.
Collapse
Affiliation(s)
- Heidi N du Preez
- Catalysis and Peptide Research Unit, University of KwaZulu-Natal, Durban, South Africa
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Johnson Lin
- School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Glenn E M Maguire
- Catalysis and Peptide Research Unit, University of KwaZulu-Natal, Durban, South Africa
- School of Chemistry and Physics, University of KwaZulu-Natal, Durban, South Africa
| | - Colleen Aldous
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Hendrik G Kruger
- Catalysis and Peptide Research Unit, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
2
|
Ueda Y, Sakai T, Yamada K, Arita K, Ishige Y, Hoshi D, Yanagisawa H, Iwao-Kawanami H, Kawanami T, Mizuta S, Fukushima T, Yamada S, Yachie A, Masaki Y. Fatal hemophagocytic lymphohistiocytosis with intravascular large B-cell lymphoma following coronavirus disease 2019 vaccination in a patient with systemic lupus erythematosus: an intertwined case. Immunol Med 2024; 47:192-199. [PMID: 38619098 DOI: 10.1080/25785826.2024.2338594] [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: 11/06/2023] [Accepted: 03/31/2024] [Indexed: 04/16/2024] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) has been recognized as a rare adverse event following the coronavirus disease 2019 (COVID-19) vaccination. We report a case of neuropsychiatric symptoms and refractory HLH in a woman with systemic lupus erythematosus (SLE) after receiving her COVID-19 vaccine treated with belimumab, later found to have intravascular large B-cell lymphoma (IVLBCL) at autopsy. A 61-year-old woman with SLE was referred to our hospital because of impaired consciousness and fever. One month prior to consulting, she received her second COVID-19 vaccine dose. Afterward, her consciousness level decreased, and she developed a high fever. She tested negative for SARS-CoV-2. Neuropsychiatric SLE was suspected; therefore, glucocorticoid pulse therapy was initiated on day 1 and 8. She had thrombocytopenia, increased serum ferritin levels and hemophagocytosis. The patient was diagnosed with HLH and treated with etoposide, dexamethasone and cyclosporine. Despite treatment, the patient died on day 75; autopsy report findings suggested IVLBCL as the underlying cause of HLH. Differentiating comorbid conditions remains difficult; however, in the case of an atypical clinical presentation, other causes should be considered. Therefore, we speculate that the COVID-19 vaccination and her autoimmune condition may have expedited IVLBCL development.
Collapse
Affiliation(s)
- Yusuke Ueda
- Department of Hematology and Immunology, Kanazawa Medical University, Uchinada, Japan
| | - Tomoyuki Sakai
- Department of Hematology and Immunology, Kanazawa Medical University, Uchinada, Japan
| | - Kazunori Yamada
- Department of Hematology and Immunology, Kanazawa Medical University, Uchinada, Japan
- Department of Medical Education, Kanazawa Medical University, Uchinada, Japan
| | - Kotaro Arita
- Department of Hematology and Immunology, Kanazawa Medical University, Uchinada, Japan
| | - Yoko Ishige
- Department of Respiratory Medicine, Kanazawa Medical University, Uchinada, Japan
| | - Daisuke Hoshi
- Department of Oncologic Pathology, Kanazawa Medical University, Uchinada, Japan
| | - Hiroto Yanagisawa
- Department of Hematology and Immunology, Kanazawa Medical University, Uchinada, Japan
| | - Haruka Iwao-Kawanami
- Department of Hematology and Immunology, Kanazawa Medical University, Uchinada, Japan
| | - Takafumi Kawanami
- Department of Hematology and Immunology, Kanazawa Medical University, Uchinada, Japan
| | - Shuichi Mizuta
- Department of Hematology and Immunology, Kanazawa Medical University, Uchinada, Japan
| | - Toshihiro Fukushima
- Department of Hematology and Immunology, Kanazawa Medical University, Uchinada, Japan
| | - Sohsuke Yamada
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Uchinada, Japan
| | - Akihiro Yachie
- Division of Medical Safety, Kanazawa University Hospital, Kanazawa, Japan
| | - Yasufumi Masaki
- Department of Hematology and Immunology, Kanazawa Medical University, Uchinada, Japan
| |
Collapse
|
3
|
Gordon ER, Adeuyan O, Kwinta BD, Schreidah CM, Fahmy LM, Queen D, Trager MH, Magro CM, Geskin LJ. Exploring cutaneous lymphoproliferative disorders in the wake of COVID-19 vaccination. SKIN HEALTH AND DISEASE 2024; 4:e367. [PMID: 38846690 PMCID: PMC11150739 DOI: 10.1002/ski2.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/08/2024] [Accepted: 03/01/2024] [Indexed: 06/09/2024]
Abstract
Background Individual reports have described lymphoproliferative disorders (LPDs) and cutaneous lymphomas emerging after administration of the COVID-19 vaccine; however, the relationship between reactions and vaccine types has not yet been examined. Objective Determine if there are cases of cutaneous LPDs associated with certain COVID-19 vaccines and their outcomes. Methods We analysed PubMed, the Vaccine Adverse Events Reporting System (VAERS), and our database for instances of biopsy-proven LPDs following COVID-19 vaccines. Results Fifty cases of biopsy-proven LPDs arising after COVID-19 vaccination were found: 37 from medical literature, 11 from VAERS and two from our institution. Geographical distribution revealed the most cases in the United States, Italy, and Greece, with single cases in Spain, Colombia, Canada, Japan, and Romania. The average age of patients was 53; with a slight male predominance (male-to-female ratio of 1.5:1). The Pfizer-BioNTech vaccine was associated with LPDs in 36/50 (72%) cases, aligning with its 70% share of the global vaccine market. Histopathology revealed CD30+ in 80% of cases. The most prevalent form of LPD was lymphomatoid papulosis (LyP, 30%). All reported cases produced favourable outcomes (either complete or near-complete remission). Therapeutic approaches ranged from observation to treatment with steroids, methotrexate, or excision. Conclusion LPDs after COVID-19 vaccination appear in the context of the same vaccines (proportionally to their global market shares), share clinical and pathological findings, and have indolent, self-limited character.
Collapse
Affiliation(s)
- Emily R. Gordon
- Vagelos College of Physicians & SurgeonsColumbia UniversityNew YorkNYUSA
| | - Oluwaseyi Adeuyan
- Vagelos College of Physicians & SurgeonsColumbia UniversityNew YorkNYUSA
| | - Bradley D. Kwinta
- Department of DermatologyColumbia University Irving Medical CenterNew YorkNYUSA
| | | | - Lauren M. Fahmy
- Vagelos College of Physicians & SurgeonsColumbia UniversityNew YorkNYUSA
| | - Dawn Queen
- Department of DermatologyColumbia University Irving Medical CenterNew YorkNYUSA
| | - Megan H. Trager
- Department of DermatologyColumbia University Irving Medical CenterNew YorkNYUSA
| | - Cynthia M. Magro
- Department of Pathology and Laboratory MedicineWeill Cornell MedicineNew YorkNYUSA
| | - Larisa J. Geskin
- Department of DermatologyColumbia University Irving Medical CenterNew YorkNYUSA
| |
Collapse
|
4
|
Verdaguer-Faja J, Valdivieso L, Fabregat-Pratdepadua M, Melendo GT, Quer A, Carrascosa JM, Boada A. Cutaneous Pseudolymphoma after COVID-19 Vaccine Injection. Indian J Dermatol 2024; 69:269-272. [PMID: 39119314 PMCID: PMC11305511 DOI: 10.4103/ijd.ijd_420_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Affiliation(s)
- Júlia Verdaguer-Faja
- From the Dermatology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España E-mail:
- Departament de Medicina, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
| | - Lorena Valdivieso
- Departament de Medicina, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
- Pathology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - Maria Fabregat-Pratdepadua
- From the Dermatology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España E-mail:
- Departament de Medicina, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
| | - Gustavo Tapia Melendo
- Departament de Medicina, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
- Pathology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - Ariadna Quer
- Departament de Medicina, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
- Pathology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - José M Carrascosa
- From the Dermatology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España E-mail:
- Departament de Medicina, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
- Institut Investigació Germanst Trias i Pujol (IGTP), Badalona, Barcelona, España
| | - Aram Boada
- From the Dermatology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España E-mail:
- Departament de Medicina, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
- Institut Investigació Germanst Trias i Pujol (IGTP), Badalona, Barcelona, España
| |
Collapse
|
5
|
Olszewska B, Zaryczańska A, Nowicki RJ, Sokołowska-Wojdyło M. Rare COVID-19 vaccine side effects got lost in the shuffle. Primary cutaneous lymphomas following COVID-19 vaccination: a systematic review. Front Med (Lausanne) 2024; 11:1325478. [PMID: 38660418 PMCID: PMC11041019 DOI: 10.3389/fmed.2024.1325478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction COVID-19 vaccines are generally safe and effective; however, they are associated with various vaccine-induced cutaneous side effects. Several reported cases of primary cutaneous lymphomas (CLs) following the COVID-19 vaccination have raised concerns about a possible association. This systematic review aims to investigate and elucidate the potential link between CLs and SARS-CoV-2 vaccines. Methods We performed a systematic literature search on PubMed, EBSCO and Scopus from January 01, 2019, to March 01, 2023, and analyzed studies based on determined eligibility criteria. The systematic review was performed based on the PRISMA protocol. Results A total of 12 articles (encompassing 24 patients) were included in this analysis. The majority of CLs were indolent cutaneous T-cell lymphomas (CTCLs) (66,7%; 16/24), with Lymphomatoid papulosis (LyP) being the most common type (33,3%; 8/24). Most patients (79,2%; 19/24) developed lesions after receiving the COVID-19 mRNA-based vaccines, and predominantly after the first immunization dose (54,2%; 13/24). The presented CLs cases exhibited a tendency to exacerbate following subsequent COVID-19 vaccinations. Nevertheless, CLs were characterized by a favorable course, leading to remission in most cases. Conclusion The available literature suggests an association between the occurrence and exacerbation of CLs with immune stimulation following COVID-19 vaccination. We hypothesize that post-vaccine CLs result from an interplay between cytokines and disrupted signaling pathways triggered by vaccine components, concurrently playing a pivotal role in the pathomechanism of CLs. However, establishing a definitive causal relationship between these events is currently challenging, primarily due to the relatively low rate of reported post-vaccine CLs. Nonetheless, these cases should not be disregarded, and patients with a history of lymphoproliferative disorders require post-COVID-19 vaccination monitoring to control the disease's course.Systematic review registrationwww.researchregistry.com, identifier [1723].
Collapse
Affiliation(s)
- Berenika Olszewska
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | | | | | | |
Collapse
|
6
|
Stephan C, Barone P, Kim J, Ma L. Primary cutaneous marginal zone lymphoproliferative disorder following COVID-19 vaccination. J Cutan Pathol 2024; 51:193-197. [PMID: 38018231 DOI: 10.1111/cup.14550] [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: 05/12/2023] [Revised: 09/04/2023] [Accepted: 10/08/2023] [Indexed: 11/30/2023]
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, COVID-19 vaccines were administered worldwide. A number of skin reactions, including primary cutaneous T-cell lymphoproliferative disorders (LPDs) were reported following COVID-19 vaccination. We report a case of primary cutaneous marginal zone lymphoproliferative disorder (PCMZLPD) secondary to COVID-19 vaccination. A 57-year-old man presented with an erythematous nodule on his left arm at the site of vaccine inoculation following his first dose of the Moderna (mRNA-1273) vaccine a few weeks prior. The nodule continued to progress in size after the second dose. A skin biopsy specimen of the nodule showed a diffuse dermal infiltrate of small to medium-sized lymphocytes with plasma cells and histiocytes. The infiltrate was composed of CD3+ T cells with CD20+ and CD79a+ B cells. The neoplastic B cells reacted with BCL-2 and were negative for BCL-6 and CD10. Kappa light chain restriction was identified by in situ hybridization. Gene rearrangement studies revealed kappa light chain monoclonality, confirming the diagnosis of PCMZLPD. The temporal association with the Moderna vaccination and the occurrence of the lesion at the inoculation site indicate a COVID-19 vaccination-induced PCMZLPD. This is one of the rare cases of PCMZLPD following COVID-19 vaccination.
Collapse
Affiliation(s)
- Carla Stephan
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine/New York-Presbyterian, New York, New York, USA
| | - Paul Barone
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine/New York-Presbyterian, New York, New York, USA
| | - Jeanyoung Kim
- Department of Dermatology, Weill Cornell Medicine/New York-Presbyterian, New York, New York, USA
| | - Linglei Ma
- Department of Pathology-Laboratory Medicine, University of Virginia, Charlottesville, VA, USA
| |
Collapse
|
7
|
Abstract
Background: During the height of the SARS CoV-2 (severe acutre respiratory syndrome coronavirus disease 2019 [COVID 19]) pandemic, there have been numerous case reports of cutaneous reactions shortly after COVID-19 vaccine administration. Most reported cases are local injection-site reactions, whereas persistent or delayed cutaneous reactions have not been as common. Methods: We present the case of an 82-year-old man with persistent rash after the second COVID-19 vaccination. Results: A specific diagnosis was confirmed after the third skin biopsy. Conclusion: Patients are frequently referred to an allergist for various cutaneous reactions that occurred after vaccination, concerned about a possible drug allergy. This case emphasizes the importance of keeping a broad differential diagnosis when encountering a persistent skin rash not resolved by oral antihistamines or steroids.
Collapse
|
8
|
Gordon ER, Kwinta BD, Schreidah CM, Fahmy LM, Adeuyan O, Queen D, Trager MH, Magro CM, Geskin LJ. Cutaneous lymphoproliferative disorders after COVID-19 vaccination: clinical presentation, histopathology, and outcomes. Leuk Lymphoma 2024; 65:48-54. [PMID: 37861685 DOI: 10.1080/10428194.2023.2270766] [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: 07/27/2023] [Accepted: 10/08/2023] [Indexed: 10/21/2023]
Abstract
Individual reports described lymphoproliferative disorders (LPDs) after COVID-19 vaccination; however, the relationship between cases is unexamined. We aim to determine if there are cases of cutaneous LPDs associated with COVID-19 vaccination and their outcomes. We present a review of world literature, vaccine registries, and two unreported cases of LPDs after COVID-19 vaccination. Review of the medical literature, VAERS, and our two cases reveal predominance of Pfizer-BioNTech vaccine, younger patients, and males. All cases resulted in favorable outcomes. Approximately 84% of cases demonstrated CD30+ positivity in their skin biopsies, suggesting that an antigenic trigger may lead to a type IV adaptive immune response, with clonal expansion of CD30+ T-cells and subsequent oncogenic mutational hits eventuating in transient LPDs. LPDs after COVID-19 vaccination appear in the context of the same vaccines (proportionally to their global market shares), share clinical and pathological findings, and have indolent, self-limited character.
Collapse
Affiliation(s)
- Emily R Gordon
- Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Bradley D Kwinta
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA
| | - Celine M Schreidah
- Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Lauren M Fahmy
- Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Oluwaseyi Adeuyan
- Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Dawn Queen
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA
| | - Megan H Trager
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA
| | - Cynthia M Magro
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Larisa J Geskin
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA
| |
Collapse
|
9
|
Saleh JS, Subtil A, Hristov AC. Primary cutaneous T-cell lymphoma: a review of the most common entities with focus on recent updates. Hum Pathol 2023; 140:75-100. [PMID: 37802757 DOI: 10.1016/j.humpath.2023.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/01/2023] [Accepted: 06/07/2023] [Indexed: 10/08/2023]
Abstract
Cutaneous T-cell lymphomas are an heterogeneous group of uncommon lymphoid neoplasms that are challenging to diagnose and require close collaboration between dermatologists, pathologists and hematologists/oncologists. This article reviews the most common cutaneous T-cell lymphomas: mycosis fungoides (both classic and variant forms) as well as its leukemic counterpart Sézary syndrome, CD30+ T-cell lymphoproliferative disorders including the ever-expanding group of lymphomatoid papulosis and primary cutaneous anaplastic large cell lymphoma, and primary cutaneous CD4+ small/medium lymphoproliferative disorder. We discuss the classic clinical and histopathologic features of these lymphomas and review how they can be distinguished from reactive entities. In particularly, updates to these diagnostic categories and current controversies in classification are highlighted. Moreover, we review the prognosis and treatment for each entity. These lymphomas exhibit variable prognosis, and therefore it is important to correctly classify atypical cutaneous T-cell infiltrates for appropriate patient treatment and prognosis. Cutaneous T-cell lymphomas are at the interface of several medical specialties; this review seeks to summarize key features of these lymphomas and highlight new and emerging insights into these lymphomas.
Collapse
Affiliation(s)
- Jasmine S Saleh
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA; Department of Dermatology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Antonio Subtil
- Department of Pathology, Royal Jubilee Hospital, University of British Columbia, Victoria, British Columbia, V8R1J8, Canada
| | - Alexandra C Hristov
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA; Department of Dermatology, University of Michigan, Ann Arbor, MI, 48109, USA.
| |
Collapse
|
10
|
Tachita T, Takahata T, Yamashita S, Ebina T, Kamata K, Yamagata K, Tamai Y, Sakuraba H. Newly diagnosed extranodal NK/T-cell lymphoma, nasal type, at the injected left arm after BNT162b2 mRNA COVID-19 vaccination. Int J Hematol 2023; 118:503-507. [PMID: 37093551 PMCID: PMC10124685 DOI: 10.1007/s12185-023-03607-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 04/25/2023]
Abstract
Anti-SARS-CoV-2 vaccines were developed in response to the coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although the BNT162b2 mRNA vaccine is effective, adverse effects have been reported. Here, we report a case of extranodal NK/T-cell lymphoma, nasal type (ENKL), of the left arm following BNT162b2 mRNA vaccination. A 73-year-old male presented with a lump in the left arm, which was the site where he received the BNT162b2 mRNA vaccine 3 months prior. He was treated with topical corticosteroids and debridement, but the tumor progressed. Additionally, fever, night sweats, and general fatigue were observed. Laboratory findings included thrombocytopenia, elevated lactate dehydrogenase, and soluble interleukin-2 receptor levels. Skin biopsy led to a diagnosis of ENKL. The patient was treated with a 50% dose of SMILE therapy and radiotherapy, resulting in regression of the tumor. It seems that latent Epstein-Barr virus (EBV)-infected NK/T cells were reactivated by vaccination and contributed to the onset of ENKL. This is the first report of ENKL after BNT162b2 mRNA vaccination. The present case highlights the possible risk of development of malignant lymphoma, including ENKL at the injection site, after BNT162b2 COVID-19 vaccination.
Collapse
Affiliation(s)
- Takuto Tachita
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, , Aomori, 036-8562, Japan.
| | - Takenori Takahata
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, , Aomori, 036-8562, Japan
| | - Satoru Yamashita
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, , Aomori, 036-8562, Japan
| | - Toru Ebina
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, , Aomori, 036-8562, Japan
| | - Kosuke Kamata
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, , Aomori, 036-8562, Japan
| | - Kazufumi Yamagata
- Department of Bioscience and Laboratory Medicine, Hirosaki University Graduate School of Health Sciences, Hirosaki, Japan
| | - Yoshiko Tamai
- Department of Transfusion and Cell Therapy Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hirotake Sakuraba
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, , Aomori, 036-8562, Japan
| |
Collapse
|
11
|
Saleh JS, Subtil A, Hristov AC. Primary cutaneous T-cell lymphoma: a review of the most common entities with focus on recent updates. Hum Pathol 2023; 138:76-102. [PMID: 37307932 DOI: 10.1016/j.humpath.2023.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/01/2023] [Accepted: 06/07/2023] [Indexed: 06/14/2023]
Abstract
Cutaneous T-cell lymphomas are an heterogeneous group of uncommon lymphoid neoplasms that are challenging to diagnose and require close collaboration between dermatologists, pathologists and hematologists/oncologists. This article reviews the most common cutaneous T-cell lymphomas: mycosis fungoides (both classic and variant forms) as well as its leukemic counterpart Sézary syndrome, CD30+ T-cell lymphoproliferative disorders including the ever-expanding group of lymphomatoid papulosis and primary cutaneous anaplastic large cell lymphoma, and primary cutaneous CD4+ small/medium lymphoproliferative disorder. We discuss the classic clinical and histopathologic features of these lymphomas and review how they can be distinguished from reactive entities. In particularly, updates to these diagnostic categories and current controversies in classification are highlighted. Moreover, we review the prognosis and treatment for each entity. These lymphomas exhibit variable prognosis, and therefore it is important to correctly classify atypical cutaneous T-cell infiltrates for appropriate patient treatment and prognosis. Cutaneous T-cell lymphomas are at the interface of several medical specialties; this review seeks to summarize key features of these lymphomas and highlight new and emerging insights into these lymphomas.
Collapse
Affiliation(s)
- Jasmine S Saleh
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA; Department of Dermatology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Antonio Subtil
- Department of Pathology, Royal Jubilee Hospital, University of British Columbia, Victoria, British Columbia, V8R1J8, Canada
| | - Alexandra C Hristov
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA; Department of Dermatology, University of Michigan, Ann Arbor, MI, 48109, USA.
| |
Collapse
|
12
|
Banoun H. mRNA: Vaccine or Gene Therapy? The Safety Regulatory Issues. Int J Mol Sci 2023; 24:10514. [PMID: 37445690 DOI: 10.3390/ijms241310514] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
COVID-19 vaccines were developed and approved rapidly in response to the urgency created by the pandemic. No specific regulations existed at the time they were marketed. The regulatory agencies therefore adapted them as a matter of urgency. Now that the pandemic emergency has passed, it is time to consider the safety issues associated with this rapid approval. The mode of action of COVID-19 mRNA vaccines should classify them as gene therapy products (GTPs), but they have been excluded by regulatory agencies. Some of the tests they have undergone as vaccines have produced non-compliant results in terms of purity, quality and batch homogeneity. The wide and persistent biodistribution of mRNAs and their protein products, incompletely studied due to their classification as vaccines, raises safety issues. Post-marketing studies have shown that mRNA passes into breast milk and could have adverse effects on breast-fed babies. Long-term expression, integration into the genome, transmission to the germline, passage into sperm, embryo/fetal and perinatal toxicity, genotoxicity and tumorigenicity should be studied in light of the adverse events reported in pharmacovigilance databases. The potential horizontal transmission (i.e., shedding) should also have been assessed. In-depth vaccinovigilance should be carried out. We would expect these controls to be required for future mRNA vaccines developed outside the context of a pandemic.
Collapse
|
13
|
Avallone G, Maronese CA, Conforti C, Fava P, Gargiulo L, Marzano AV, Massone C, Mastorino L, Paradisi A, Pileri A, Quaglino P, Rizzo N, Ribero S, Roccuzzo G, Tavoletti G, Vignoli CA, Zalaudek I, Berti E, Alberti-Violetti S. Real-world data on primary cutaneous lymphoproliferative disorders following SARS-CoV-2 vaccination: A multicentre experience from tertiary referral hospitals. J Eur Acad Dermatol Venereol 2023; 37:e451-e455. [PMID: 36469002 PMCID: PMC9877594 DOI: 10.1111/jdv.18806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Gianluca Avallone
- Department of Medical Sciences, University of Turin, Dermatology Clinic, Turin, Italy.,Dermatology Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Carlo Alberto Maronese
- Dermatology Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Claudio Conforti
- Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy
| | - Paolo Fava
- Department of Medical Sciences, University of Turin, Dermatology Clinic, Turin, Italy
| | - Luigi Gargiulo
- Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | | | - Luca Mastorino
- Department of Medical Sciences, University of Turin, Dermatology Clinic, Turin, Italy
| | - Andrea Paradisi
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy.,Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Pileri
- Dermatology Unit, IRCCS of Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Pietro Quaglino
- Department of Medical Sciences, University of Turin, Dermatology Clinic, Turin, Italy
| | - Nathalie Rizzo
- Department of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Simone Ribero
- Department of Medical Sciences, University of Turin, Dermatology Clinic, Turin, Italy
| | - Gabriele Roccuzzo
- Department of Medical Sciences, University of Turin, Dermatology Clinic, Turin, Italy
| | - Gianluca Tavoletti
- Dermatology Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Carlo Alberto Vignoli
- Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy
| | - Emilio Berti
- Dermatology Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Silvia Alberti-Violetti
- Dermatology Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| |
Collapse
|
14
|
Yanagida E, Kubota A, Miyoshi H, Ohshima K, Kawakita T, Murayama T. The case of T-ALL presenting with NK phenotype after COVID-19 vaccination. Pathol Res Pract 2023; 242:154310. [PMID: 36706586 PMCID: PMC9840814 DOI: 10.1016/j.prp.2023.154310] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 01/09/2023] [Accepted: 01/14/2023] [Indexed: 01/16/2023]
Abstract
NK-lymphoblastic leukemia/lymphoma (NK-LL) is an extremely rare hematopoietic tumor consisting of natural killer (NK) precursor cells, and their lineage overlaps with T-cells, making it challenging to diagnose. COVID-19 vaccination is recommended for people with a risk of aggravation such as cancer-bearing patients, including hematopoietic tumors. We present a 55-year-old man who had cervical lymph node swelling post vaccination for COVID-19. Hematological malignancy was suspected due to the presence of atypical lymphoid cells with an elevated IL-2R in laboratory data. Tumor cells were positive for CD7, CD56, cyCD3, and terminal deoxynucleotidyl transferase (TdT) evidenced through flow cytometry of the bone marrow and the lymph node. The histopathological findings showed monotonous tumor cell proliferation, the cells being positive for CD3 and TdT in the bone marrow and they were positive for CD3, TdT, and CD56 in lymph node. Even though these findings suggested NK-LL, clonal T-cell receptor (TCR) β gene rearrangement by Southern blot hybridization was observed in the bone marrow. TCRβ rearrangement led to the final diagnosis of T-cell lymphoblastic leukemia (T-ALL). The causal relationship between COVID-19 vaccination and carcinogenesis is not clear, and more cases need to be studied in order to elucidate the relationship between the two factors.
Collapse
Affiliation(s)
- Eriko Yanagida
- Department of Pathology, National Hospital Organization, Kumamoto Medical Center, Kumamoto, Japan; Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
| | - Akira Kubota
- Department of Hematology, National Hospital Organization, Kumamoto Medical Center, Kumamoto, Japan
| | - Hiroaki Miyoshi
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Koichi Ohshima
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Toshiro Kawakita
- Department of Hematology, National Hospital Organization, Kumamoto Medical Center, Kumamoto, Japan
| | - Toshihiko Murayama
- Department of Pathology, National Hospital Organization, Kumamoto Medical Center, Kumamoto, Japan
| |
Collapse
|
15
|
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.
Collapse
|
16
|
Eens S, Van Hecke M, Favere K, Tousseyn T, Guns PJ, Roskams T, Heidbuchel H. B-cell lymphoblastic lymphoma following intravenous BNT162b2 mRNA booster in a BALB/c mouse: A case report. Front Oncol 2023; 13:1158124. [PMID: 37197431 PMCID: PMC10183601 DOI: 10.3389/fonc.2023.1158124] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/13/2023] [Indexed: 05/19/2023] Open
Abstract
Unprecedented immunization campaigns have been rolled out worldwide in an attempt to contain the ongoing COVID-19 pandemic. Multiple vaccines were brought to the market, among two utilizing novel messenger ribonucleic acid technology. Despite their undisputed success in decreasing COVID-19-associated hospitalizations and mortality, various adverse events have been reported. The emergence of malignant lymphoma is one of such rare adverse events that has raised concern, although an understanding of the mechanisms potentially involved remains lacking. Herein, we present the first case of B-cell lymphoblastic lymphoma following intravenous high-dose mRNA COVID-19 vaccination (BNT162b2) in a BALB/c mouse. Two days following booster vaccination (i.e., 16 days after prime), at only 14 weeks of age, our animal suffered spontaneous death with marked organomegaly and diffuse malignant infiltration of multiple extranodal organs (heart, lung, liver, kidney, spleen) by lymphoid neoplasm. Immunohistochemical examination revealed organ sections positive for CD19, terminal deoxynucleotidyl transferase, and c-MYC, compatible with a B-cell lymphoblastic lymphoma immunophenotype. Our murine case adds to previous clinical reports on malignant lymphoma development following novel mRNA COVID-19 vaccination, although a demonstration of direct causality remains difficult. Extra vigilance is required, with conscientious reporting of similar cases and a further investigation of the mechanisms of action explaining the aforementioned association.
Collapse
Affiliation(s)
- Sander Eens
- Laboratory of Physiopharmacology, Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton (GENCOR), University of Antwerp, Antwerp, Belgium
- Research Group Cardiovascular Diseases, Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton (GENCOR), University of Antwerp, Antwerp, Belgium
- *Correspondence: Sander Eens,
| | - Manon Van Hecke
- Laboratory of Translational Cell and Tissue Research, Department of Imaging and Pathology, University of Leuven, Leuven, Belgium
| | - Kasper Favere
- Laboratory of Physiopharmacology, Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton (GENCOR), University of Antwerp, Antwerp, Belgium
- Research Group Cardiovascular Diseases, Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton (GENCOR), University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Thomas Tousseyn
- Laboratory of Translational Cell and Tissue Research, Department of Imaging and Pathology, University of Leuven, Leuven, Belgium
| | - Pieter-Jan Guns
- Laboratory of Physiopharmacology, Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton (GENCOR), University of Antwerp, Antwerp, Belgium
| | - Tania Roskams
- Laboratory of Translational Cell and Tissue Research, Department of Imaging and Pathology, University of Leuven, Leuven, Belgium
| | - Hein Heidbuchel
- Research Group Cardiovascular Diseases, Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton (GENCOR), University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
| |
Collapse
|
17
|
Revenga-Porcel L, Peñate Y, Granados-Pacheco F. Anaplastic large cell lymphoma at the SARS-CoV2 vaccine injection site. J Eur Acad Dermatol Venereol 2023; 37:e32-e34. [PMID: 36166359 DOI: 10.1111/jdv.18615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/21/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Laura Revenga-Porcel
- Department of Dermatology, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
| | - Yeray Peñate
- Department of Dermatology, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
| | - Francisco Granados-Pacheco
- Department of Pathology, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
| |
Collapse
|
18
|
Bresler SC, Menge TD, Tejasvi T, Carty SA, Hristov AC. Two cases of challenging cutaneous lymphoid infiltrates presenting in the context of COVID-19 vaccination: A reactive lymphomatoid papulosis-like eruption and a bona fide lymphoma. J Cutan Pathol 2022; 50:213-219. [PMID: 36437812 PMCID: PMC9878077 DOI: 10.1111/cup.14371] [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: 06/23/2022] [Revised: 08/24/2022] [Accepted: 11/26/2022] [Indexed: 11/29/2022]
Abstract
COVID-19 infection and vaccination may be associated with a wide variety of cutaneous and immune manifestations. Here, we describe two patients who presented with monoclonal cutaneous T-cell infiltrates that showed cytologic and immunophenotypic features concerning for lymphoma shortly following COVID-19 vaccination. In one case, the eruption completely resolved. The second patient showed initial resolution, but her disease recurred and progressed following a breakthrough SARS-CoV-2 infection. These cases suggest that immune stimulation following exposure to SARS-Cov-2 protein(s) in vaccine or infection may facilitate the development of a lymphoma or lymphoproliferative disorder in susceptible individuals. Moreover, they show that separating these cases from pseudolymphomatous reactive conditions is often challenging and requires close clinical correlation.
Collapse
Affiliation(s)
- Scott C. Bresler
- Department of Pathology, Michigan MedicineUniversity of MichiganAnn ArborMichiganUSA,Department of Dermatology, Michigan MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Tyler D. Menge
- Department of Dermatology, Michigan MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Trilokraj Tejasvi
- Department of Dermatology, Michigan MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Shannon A. Carty
- Division of Hematology/OncologyMichigan Medicine, University of MichiganAnn ArborMichiganUSA,Department of Internal MedicineMichigan Medicine, University of MichiganAnn ArborMichiganUSA
| | - Alexandra C. Hristov
- Department of Pathology, Michigan MedicineUniversity of MichiganAnn ArborMichiganUSA,Department of Dermatology, Michigan MedicineUniversity of MichiganAnn ArborMichiganUSA
| |
Collapse
|
19
|
Li HOY, Lipson J. New mycosis fungoides-like lymphomatoid reaction following COVID-19 vaccination: A case report. SAGE Open Med Case Rep 2022; 10:2050313X221131859. [PMID: 36267336 PMCID: PMC9577074 DOI: 10.1177/2050313x221131859] [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] [Indexed: 11/05/2022] Open
Abstract
Numerous cutaneous side effects arising from COVID-19 vaccination have been
reported. Mycosis fungoides (MF) is a rare indolent form of cutaneous t-cell
lymphoma. While the pathogenesis of MF is not well understood, it is thought to
involve immune dysregulation. There have been reports of COVID-19 vaccination
induced flares and recurrences of cutaneous lymphomas and lymphomatoid
reactions. We present the first reported case of COVID-19 vaccine induced
MF-like lymphomatoid reaction.
Collapse
Affiliation(s)
- Heidi Oi-Yee Li
- Division of Dermatology, The Ottawa
Hospital, University of Ottawa, Ottawa, ON, Canada,Faculty of Medicine, University of
Ottawa, Ottawa, ON, Canada
| | - Jennifer Lipson
- Division of Dermatology, The Ottawa
Hospital, University of Ottawa, Ottawa, ON, Canada,Jennifer Lipson, Division of Dermatology,
The Ottawa Hospital, University of Ottawa, 737 Parkdale Ave, 4th Floor
Dermatology, Ottawa, ON K1Y 1J8, Canada.
| |
Collapse
|
20
|
Mohseni Afshar Z, Tavakoli Pirzaman A, Liang JJ, Sharma A, Pirzadeh M, Babazadeh A, Hashemi E, Deravi N, Abdi S, Allahgholipour A, Hosseinzadeh R, Vaziri Z, Sio TT, Sullman MJM, Barary M, Ebrahimpour S. Do we miss rare adverse events induced by COVID-19 vaccination? Front Med (Lausanne) 2022; 9:933914. [PMID: 36300183 PMCID: PMC9589063 DOI: 10.3389/fmed.2022.933914] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has caused many complications, the invention of coronavirus disease 2019 (COVID-19) vaccines has also brought about several adverse events, from common side effects to unexpected and rare ones. Common vaccine-related adverse reactions manifest locally or systematically following any vaccine, including COVID-19 vaccines. Specific side effects, known as adverse events of particular interest (AESI), are unusual and need more evaluation. Here, we discuss some of the most critical rare adverse events of COVID-19 vaccines.
Collapse
Affiliation(s)
- Zeinab Mohseni Afshar
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Jackson J. Liang
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, MI, United States
| | - Akanksha Sharma
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, United States
| | - Marzieh Pirzadeh
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Arefeh Babazadeh
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Erfan Hashemi
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Niloofar Deravi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sadaf Abdi
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Amirreza Allahgholipour
- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rezvan Hosseinzadeh
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Zahra Vaziri
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Terence T. Sio
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States
| | - Mark J. M. Sullman
- Department of Social Sciences, University of Nicosia, Nicosia, Cyprus
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Mohammad Barary
- Student Research Committee, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Ebrahimpour
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| |
Collapse
|
21
|
Zamfir MA, Moraru L, Dobrea C, Scheau AE, Iacob S, Moldovan C, Scheau C, Caruntu C, Caruntu A. Hematologic Malignancies Diagnosed in the Context of the mRNA COVID-19 Vaccination Campaign: A Report of Two Cases. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:874. [PMID: 35888593 PMCID: PMC9316988 DOI: 10.3390/medicina58070874] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND During the last two years, the COVID-19 pandemic led to millions of disease-related deaths worldwide. The efforts of the scientific community facing this global challenge resulted in outstanding achievements. Thus, within one year, new mRNA-based vaccines against SARS-CoV-2 viral infection were released, providing highly efficient protection and showing a very good safety profile in the general population. However, clinical data collection after vaccination is a continuous process for the long-term safety of any new medical product. The aim of our paper is to present two cases of hematological malignancies: diffuse large B-cell non-Hodgkin lymphoma and T/NK-cell lymphoma, diagnosed shortly after the administration of the mRNA COVID-19 vaccine. METHODS AND RESULTS Case 1: A female patient was admitted with a suspicious cervical mass that emerged within one week after the administration of second dose of the BNT162b2 COVID-19 vaccine. Surgical removal followed by pathology assessment of the specimen confirmed the diagnosis of diffuse large B-cell non-Hodgkin lymphoma. Case 2: A male patient was admitted with multiple ulcerative oral lesions arising on the third day after the initial dose of the BNT162b2 COVID-19 vaccine. These lesions had a progressive character and during the following months were complicated with repetitive episodes of heavy oral bleeding, requiring blood transfusions. The incisional biopsy of the lesions and pathological assessment of the specimens confirmed the diagnosis of T/NK-cell lymphoma. CONCLUSIONS The safety profile of the mRNA-based vaccines is an undeniable fact. In most cases, suspicions of potentially aggressive side effects were ruled out, proving to be transient post-vaccine reactions. Clinicians should remain alert to report any potentially aggressive manifestations emerging in the context of mRNA COVID-19 vaccination, such as these cases of hematological malignancies, in order to promote additional investigations on the particular mechanisms of action of COVID-19 vaccines and to provide the best medical care to the patients.
Collapse
Affiliation(s)
- Maria-Alexandra Zamfir
- Department of Oral and Maxillofacial Surgery, “Carol Davila” Central Military Emergency Hospital, 010825 Bucharest, Romania; (M.-A.Z.); (L.M.); (A.C.)
| | - Liliana Moraru
- Department of Oral and Maxillofacial Surgery, “Carol Davila” Central Military Emergency Hospital, 010825 Bucharest, Romania; (M.-A.Z.); (L.M.); (A.C.)
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, “Titu Maiorescu” University, 031593 Bucharest, Romania
| | - Camelia Dobrea
- Department of Hematology, Fundeni Clinical Institute, 022328 Bucharest, Romania;
- Department of Hematology, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
| | - Andreea-Elena Scheau
- Department of Radiology and Medical Imaging, Fundeni Clinical Institute, 022328 Bucharest, Romania;
| | - Simona Iacob
- Pathology Laboratory Personal Genetics, 010987 Bucharest, Romania;
| | - Cosmin Moldovan
- Faculty of Medicine, “Titu Maiorescu” University, 031593 Bucharest, Romania;
- General Surgery Ward, Witting Clinical Hospital, 010243 Bucharest, Romania
| | - Cristian Scheau
- Department of Physiology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Constantin Caruntu
- Department of Physiology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Dermatology, “Prof. N.C. Paulescu” National Institute of Diabetes, Nutrition and Metabolic Diseases, 011233 Bucharest, Romania
| | - Ana Caruntu
- Department of Oral and Maxillofacial Surgery, “Carol Davila” Central Military Emergency Hospital, 010825 Bucharest, Romania; (M.-A.Z.); (L.M.); (A.C.)
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, “Titu Maiorescu” University, 031593 Bucharest, Romania
| |
Collapse
|
22
|
Koumaki D, Marinos L, Nikolaou V, Papadakis M, Zografaki K, Lagoudaki E, Kotopouli FE, Krasagakis K, Krueger-Krasagakis SE. Lymphomatoid papulosis (LyP) after AZD1222 and BNT162b2 COVID-19 vaccines. Int J Dermatol 2022; 61:900-902. [PMID: 35584258 PMCID: PMC9347989 DOI: 10.1111/ijd.16296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 04/28/2022] [Accepted: 05/05/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Dimitra Koumaki
- Dermatology Department, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Leonidas Marinos
- Department of Hemopathology, Evangelismos General Hospital, Athens, Greece
| | - Vasiliki Nikolaou
- Dermatology Department, Cutaneous Lymphoma Clinic, Medical School, "A. Sygros" Hospital for Skin Diseases, National & KapodIstrian University of Athens, Athens, Greece
| | - Marios Papadakis
- Department of Surgery II, Witten/Herdecke University, Witten, Germany
| | - Kyriaki Zografaki
- Dermatology Department, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Eleni Lagoudaki
- Department of Pathology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | | | | | | |
Collapse
|
23
|
Mizutani M, Mitsui H, Amano T, Ogawa Y, Deguchi N, Shimada S, Miwa A, Kawamura T, Ogido Y. Two cases of axillary lymphadenopathy diagnosed as diffuse large B‐cell lymphoma developed shortly after
BNT162b2 COVID
‐19 vaccination. J Eur Acad Dermatol Venereol 2022; 36:e613-e615. [PMID: 35398921 PMCID: PMC9114986 DOI: 10.1111/jdv.18136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/05/2022] [Indexed: 11/29/2022]
Affiliation(s)
- M. Mizutani
- Department of Dermatology Tokyo‐kita Medical Center
| | - H. Mitsui
- Department of Dermatology, Faculty of Medicine University of Yamanashi
| | - T. Amano
- Department of Pathology Tokyo‐kita Medical Center
| | - Y. Ogawa
- Department of Dermatology, Faculty of Medicine University of Yamanashi
| | - N. Deguchi
- Department of Dermatology, Faculty of Medicine University of Yamanashi
| | - S. Shimada
- Department of Dermatology, Faculty of Medicine University of Yamanashi
| | - A. Miwa
- Department of Hematology Tokyo‐kita Medical Center
| | - T. Kawamura
- Department of Dermatology, Faculty of Medicine University of Yamanashi
| | - Y. Ogido
- Department of Dermatology Tokyo‐kita Medical Center
| |
Collapse
|
24
|
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.
Collapse
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
| |
Collapse
|
25
|
AZD-1222. REACTIONS WEEKLY 2022. [PMCID: PMC8853882 DOI: 10.1007/s40278-022-10181-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
26
|
Fernández-Figueras MT. Dermatopathology of COVID-19 infection and vaccination. PATHOLOGIE (HEIDELBERG, GERMANY) 2022; 43:114-118. [PMID: 36197514 PMCID: PMC9533285 DOI: 10.1007/s00292-022-01126-9] [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] [Accepted: 09/02/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Many peculiar skin changes have been described in relation to both coronavirus disease 2019 (COVID-19) infection and vaccination. OBJECTIVE This paper provides an overview of these dermatologic manifestations, focusing on their dermatopathological appearances. RESULTS Most COVID-19 patients develop variegated maculopapular eruptions with a combination of histological patterns commonly including keratinocyte apoptosis and eosinophilia. Urticaria-like lesions often show a combination of spongiotic and lichenoid patterns and are more frequent in individuals with severe disease. Vesicular lesions can be disseminated; in some cases, they become pustular and in others show dyskeratosis and a peculiar form of ballooning. Some patients develop vesicular Grover disease on the trunk. Young patients with a strong immunological response can eliminate the virus easily but may develop chilblains as a consequence of the high interferon response. Conversely, older individuals with immunosenescence and a tendency toward hypercoagulability can present livedoid and ischemic areas. Regarding COVID-19 vaccination, hypersensitivity reactions are most frequent, including "COVID-arm." Nonetheless, a combination of local and systemic cutaneous manifestations (reactogenicity) is commonly seen. Histopathologically, lichenoid and spongiotic changes and a variable number of eosinophils are typical of rashes characterized by papules and plaques. Other dermatological side effects of COVID-19 vaccination include lesions mimicking well-defined dermatoses such as lichen planus or bullous pemphigoid and triggering of collagenous diseases. CONCLUSION Well-characterized skin manifestations of coronavirus disease 2019 (COVID-19) include chilblains, livedo necrotic lesions, vesicular eruptions, urticarial lesions, and maculopapular eruptions. Hypersensitivity reactions are common after SARS-CoV‑2 mRNA vaccination. Vaccine reactions may also mimic other dermatosis such as bullous pemphigoid or lichen planus, stimulate herpes reactivation, or trigger the development of autoimmune diseases.
Collapse
Affiliation(s)
- María-Teresa Fernández-Figueras
- grid.440254.30000 0004 1793 6999Dept Anatomic pathology., Hospital Universitari General de Catalunya. Grupo Quironsalud, Carrer Pedro i Pons, 1, 08195 Sant Cugat del Vallès (Barcelona), Spain
| |
Collapse
|