ABSTRACT
COVID-19 is inflicted by SARS-CoV-2 and resulted in a global health crisis that necessitated the urgency of vaccine development to prevent its spreading among the public. Pfizer-BioNTech COVID-19 is one of the emergency use authorized (EUA) vaccines. This vaccine is efficacious against the SARS-CoV-2 virus; nonetheless, recipients have frequently reported side effects. Recipients of this vaccine experienced miscellaneous side effects like fatigue and headache. However, cutaneous eruptions of varying degrees of severity and involvements have been manifesting post-vaccination. Dermatological eruptions following vaccination against COVID-19 disease are poorly recognized. Dermatological manifestations triggered post-vaccination differ in the clinical context and patient's demographic features. The only constant factor is various clinical and histopathological relations to establish the diagnosis of cutaneous eruption post-vaccination. Herein, we report a case of an 18-year-old male with T-cell acute lymphocytic lymphoma (ALL) in remission since August 2018 and other comorbidities. After the administration of the first dose of the Pfizer-BioNTech COVID-19 vaccine, the patient developed pruritic eczematous eruption presenting as grouped erythematous-violaceous papulovesicular lesions with fine scales over his upper and lower extremities. These eruptions started two days after the administration of the vaccine. This eruption became generalized 21 days after receiving the second dose of the Pfizer-BioNTech COVID-19 vaccine. Clinical suspicion of the drug-induced vesicular eruption was suspected; thus, a biopsy was obtained and showed erosions and mixed inflammatory cell infiltrate. From a clinical and histopathological correlation, vesicular eruption following vaccination with Pfizer-BioNTech COVID-19 was confirmed. Nevertheless, other diagnoses cannot be ruled out, but from the clinical-histopathological association, the vaccine-inflicted eruption is the likely culprit. Reports are crucial to understanding the nature of such dermatological manifestation after emerging diseases and counteractions like vaccinations. The dermatological manifestations are vaguely recognized; thus, by reporting on the cases similar to the case in this report, more data will be available to understand the nature and underlying cause of such eruptions.
ABSTRACT
Coronavirus disease 2019 (COVID-19) emerged in Thailand in January 2020. Thailand was the first to report a confirmed case outside China. Cutaneous eruption in COVID-19 has been reported since the disease became pandemic but limited in tropical countries such as Thailand. The aim of this study was to observe the incidence, characteristics and relation of cutaneous eruption with COVID-19 at Bamrasnaradura Infectious Diseases Institute, a referral center of emerging infectious diseases in Thailand. An observational descriptive study observed the incidence and characteristics of cutaneous eruption in 204 COVID-19-infected patients at Bamrasnaradura Infectious Diseases Institute. We report five patients, who represented six incidences of skin eruption with four characteristics: maculopapular rash (50%), acute generalized exanthematous pustulosis (16.67%), Stevens-Johnson syndrome (16.67%) and urticarial vasculitis (16.67%). Incidences of cutaneous eruption in COVID-19 at Bamrasnaradura Infectious Diseases Institute were low. Most of the incidents were associated with medication used to treat COVID-19 infection, so drug allergy cannot be excluded as a cause of the rashes. Therefore, drug allergy should always be ruled out, and skin manifestation in COVID-19-infected patients should be further observed.