ABSTRACT
Case Report: A 28 year old male with a past medical history of hypothyroidism and positive ANA presented to an outpatient dermatology clinic with a diffuse pruritic rash two weeks after the administration of his first Moderna COVID booster vaccine. He denied any other accompanying symptoms such as fever or chills as well as any similar rashes to prior doses of the Moderna COVID vaccine. The rash consisted of pink erythematous minimally scaly papules, thin plaques and patches involving the left and right dorsal hands, forearms, wrists, face, neck and left shoulder. The remainder of the patient's skin including the bilateral lower extremities, the eyelids, conjunctiva and oral mucosa was clear. The patient denied any similar rashes in the past. The patient denied any allergies to medications, or food or environmental allergies. He denied any notable contact allergen exposures, including to soaps, lotions, and cosmetic products. The patient also denied any significant family history or past surgical history. The patient was on Armour Thyroid for hypothyroidism and testosterone for low levels since age eighteen. The patient was started on cetirizine 10 mg once daily for the rash with minimal improvement. Autoimmune workup for the rash was notable for an elevated anti-RNP and as the patient's past medical history included Raynaud's phenomenon and ANA positivity for ten years, the patient was diagnosed with mixed connective tissue disease (MCTD). Autoimmune conditions can often have an indolent course, where symptoms progressively develop and worsen. MCTD is an autoimmune overlap syndrome that can consist of the following three connective tissue diseases: systemic lupus erythematosus, scleroderma, and polymyositis. Millions of individuals across the world are receiving COVID vaccines to protect themselves and members of their community, and it is of utmost importance that we continue to investigate adverse events. Although of low incidence, these rare effects have the ability to impact large numbers of people within both healthy and immunocompromised populations. It is critical that we examine and document them in a rigorous manner, to ensure safe vaccine delivery and reassure the public about vaccine safety overall.
ABSTRACT
Corona virus, also known as covid-19 is an infectious viral disease caused by SARS-CoV-2. The disease has caused a global pandemic. It was first identified in December 2019 in Wuhan province of China and has been declared as global pandemic in March 2020 by World Health Organisation. Cutaneous manifestations in Covid-19 have not been widely discussed. Here we are presenting a case of 14 year old boy who came to our skin OPD with the complaint of urticaria which was not responding to treatment. The boy came with complaint of rashes all over the body associated with fever, throat pain, cough, loss of smell and taste sensation since 2 days. We did a complete blood count and CRP level. On investigation we found his total leucocytes count to be 28,900/cmm, Polymorphs were 90%, Lmphocytes 6% and CRP value was 47mg/L. He was prescribed injection Pheniramine maleate 2cc IM stat, T. Levocetrizine 5mg HSx15 days, T.Azitromycin 500mg once daily x 7 days and moisturising lotion and patient was referred to Covid hospital where he was found to be Covid positive.
ABSTRACT
Background: Polyethylene glycols (PEGs), also called macrogols, are molecules that cause allergic reactions in individuals who are sensitized to them. Their relevance lies in their popularity as they are usually found in many drugs and skin products such as laxatives, cosmetics, antibiotics, corticoids, contrast dyes, vitamin complexes These compounds have recently attained certain prominence due to their presence in several vaccines developed against the global pandemic of SARS-CoV2. Allergic to these substances individuals cannot be vaccinated, as PEGs or polysorbate 80 (which cross-reacts with PEGs) may be included in the vaccine. This research presents a clinical case of a 57-year man who had had several local skin reactions with associated itching, caused by different cosmetic products and Betadine® (povidone-iodine ointment) in gel. He also developed a similar clinical picture, as well as wheezing, by means of Moviprep® (a laxative), but the same day he tolerated another laxative, Casenglicol®. Additionally, he suffered a reaction to Vincigrip® (paracetamol/pseudoephedrine hydrochloride/chlorpheniramine maleate), but tolerated paracetamol alone Method: The tests have been practised on this patient are standard patch-tests, photopatch testing with sunscreen lotions, prick-tests and intra dermo-reaction (1:100) with PEGs, and controlled exposure test with laxatives Citraflett® and Vincigrip® (both of them without PEGs). Results: All these tests cast negative results but the intra dermoreaction test. In this case, the patient developed facial and oropharynx itchiness, scattered wheals, and dyspnoea, which decreased after administrating adrenaline, corticoids, and antihistamines. The patient was diagnosed allergy to PEG and has been advised from receiving any SARS-CoV2 vaccine at all. Conclusion: It is of great relevance to diagnose allergic to PEG patients, for two main reasons. First, due to the frequent presence of PEGs in medicaments and cosmetics. Many times they may be overlooked as they are included only in some formulations or brands of a same product. Thus, in consequence, these patients cannot be administrated some vaccines against SARS-CoV2 containing PEG or polysorbate.