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1.
Chest ; 162(4):A2217-A2218, 2022.
Article in English | EMBASE | ID: covidwho-2060912

ABSTRACT

SESSION TITLE: Autoimmune Diseases Gone Wild: Rare Cases of Pulmonary Manifestations SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 01:35 pm - 02:35 pm INTRODUCTION: Post-Covid-19 Multisystem Inflammatory Syndrome (MIS) is a severe hyperinflammatory syndrome associated with either the acute or recovery phase of covid-19 infection affecting multiple organ systems requiring hospitalization. This syndrome has been described in both children (MIS-C) and adults (MIS-A). Several case reports and systematic reviews have reported an association between post-covid-19 MIS-A and several autoimmune diseases. CASE PRESENTATION: We herein report a case of a 27-year-old female with no known chronic medical condition and a non-contributory family history who was diagnosed with post-covid-19 multisystem inflammatory syndrome in adults (MIS-A). She presented with generalized partial thickness erythematous skin ulcerations with tender blistering and painful erosion of her mucus membranes (oral and vaginal mucosa). This was diagnosed as Steven Johnsons syndrome. She was pulsed with intravenous methylprednisone. During this therapy, she progressed to severe acute respiratory distress syndrome (ARDS) requiring mechanical ventilation (fig 1). Bronchoscopy revealed mild pulmonary hemorrhage fig 2a&b). Serological testing heralded a new onset systemic lupus erythematosus in light of positive antinuclear antibodies, anti Ds DNA and anti Smith antibodies. Her course was complicated by significant proteinuria and an active renal cast suggestive of lupus nephritis. This necessitated further treatment for active lupus. She was successfully extubated and discharged home. DISCUSSION: We arrived at the diagnosis of post-covid-19 multisystem inflammatory syndrome in adults (MIS-A) in light of her presenting with fever, hypotension, persistent sinus tachycardia and new onset atrial fibrillation), acute pancreatitis, acute kidney injury, elevation in transaminases, new onset skin rash, elevated inflammatory markers and a recent history of positive SARS-CoV-2 infection. Covid-19 has been reported to induce wide spread vasculitis resulting in MIS-A or MIS-C by triggering type 3 hypersensitivity (1). Also, multiple case reports and systemic reviews have reported a direct association between MIS-A and several autoimmune diseases including SLE, SJS (2). The patient recovered with high dose corticosteroid and supportive therapy indicating her severe ARDS was most likely due associated to SJS, SLE and MIS-A. Clinicians should also keep in mind that SARS-CoV-2 PCR swab may be negative at the time patient presents with symptoms of MIS-A as the infection might have occurred about 4-5weeks prior just as in our patient(3) CONCLUSIONS: We cannot underscore enough the importance of clinicians having a high index of suspicion for this syndrome in patients with acute or recent covid-19 infection, with or without a positive PCR covid-19 test. Early involvement of a multidisciplinary approach and appropriate management is essential to mitigate morbidity and mortality in these patients. Reference #1: Roncati L, Ligabue G, Fabbiani L, Malagoli C, Gallo G, Lusenti B, et al. Type 3 hypersensitivity in COVID-19 vasculitis. Clin Immunol Orlando Fla. 2020 Aug;217:108487. Reference #2: Gracia-Ramos AE, Martin-Nares E, Hernández-Molina G. New Onset of Autoimmune Diseases Following COVID-19 Diagnosis. Cells [Internet]. 2021 Dec 20 [cited 2022 Mar 22];10(12):3592. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8700122/ Reference #3: Morris SB. Case Series of Multisystem Inflammatory Syndrome in Adults Associated with SARS-CoV-2 Infection — United Kingdom and United States, March–August 2020. MMWR Morb Mortal Wkly Rep [Internet]. 2020 [cited 2022 Mar 22];69. Available from: https://www.cdc.gov/mmwr/volumes/69/wr/mm6940e1.htm DISCLOSURES: No relevant relationships by Isaac Ikwu No relevant relationships by Anthony Lyonga Ngonge No relevant relationships by Alem Mehari No relevant relationships by Noordeep Panesar no disclosure on file for Vis al Poddar;No relevant relationships by Emnet Yibeltal

3.
Pediatr Int ; : e15366, 2022 Sep 27.
Article in English | MEDLINE | ID: covidwho-2052900
4.
Drug Safety ; 45(10):1257, 2022.
Article in English | ProQuest Central | ID: covidwho-2046676

ABSTRACT

Introduction: In Lombardy and Piedmont (Northern Italy, about 14 million people) the GRESIF pharmacovigilance network project, aimed to collect, assess, treat and prevent severe systemic drug reactions was activated in 2021, supported by the Italian Medicines Agency (AIFA). GRESIF involves regional and hospital pharmacovigilance centers, and several hospital wards: burn, dermatology, allergology, internal medicine, infectivology and intensive care departments. The registry collects in the National Pharmacovigilance Network all reports of suspected adverse drug reactions (ADRs) concerning Toxic Epidermal Necrolysis (TEN), Stevens-Johnson Syndrome (SJS), Drug reaction with eosinophilia and systemic symptoms (DRESS) and Acute Generalized Exanthematous Pustulosis (AGEP). Objective: The specific objectives of the study are to early detect severe systemic ADRs, evaluate their incidence, morbidity and mortality rates, focus on new generation drugs such as RNA antivirals and oncological drugs, implement and optimize guidelines, manage long-term sequelae by follow-up and create a consultable web-based database. Methods: We have drawn up the guidelines [1,2], through a multidisciplinary approach in order to improve the management of very complex patients even in facilities that are not habitually involved in the treatment of these pathologies. This document aims to support professionals in standardizing diagnostic criteria and methods of therapeutic approach. Its useful to inform the general practitioner about responsible drugs and give some information about risk /benefit on the riexposure. Results: In 2021, 27 cases of SJS/TEN, 18 cases of DRESS and no cases of AGEP were collected. There is a female prevalence (25 cases out 44);the age range is from 20 to 93 years. The median age of patients in Lombardy and in Piedmont is respectively 55 and 66 for females, 47 and 63 for males. The total mortality for cases of SJS/ TEN is about 19% and for DRESS we have no deaths. More frequent suspected drugs are antibiotics, followed by allopurinol and anticonvulsants. Noteworthy is the presence of 4 cases of severe ADR related to anti Covid19 RNA vaccines. In all cases, according to the guidelines, the timely discontinuation of the responsible drug was fundamental as the general management. Furthermore we started a study for the HLA typing of these patients. We enrolled 18 cases and the results showed that 6 patients who received allopurinol were all positive to HLA B 58:01. Conclusion: Despite being extremely rare but serious reactions, the absolute need to implement shared diagnostic and therapeutic protocols to be applied promptly is highlighted, in order to reduce both patient mortality and long-term sequelae.

5.
Journal of General Internal Medicine ; 37:S507, 2022.
Article in English | EMBASE | ID: covidwho-1995871

ABSTRACT

CASE: A 22-year-old woman with h/o asthma initially presented to the hospital with lip swelling and sore throat. She tested positive for COVID-19 and received a casirivimab-imdevimab (monoclonal antibody) infusion. She returned a week later with worsening lip swelling, dysphagia and conjunctivitis. Physical exam revealed edematous lips with vesicular lesions, no tongue swelling, tonsillar exudate, 4+ conjunctival injection bilaterally with purulent discharge, and shallow clean based clitoral ulceration. She reports no history of allergic reactions, angioedema or exposure to new medications. Nasopharyngolaryngoscopy showed no laryngeal edema but visualized exudates throughout the supraglottis and glottis. C4, ANA, CMV, EBV, throat and blood cultures were negative. STI testing was trichomonas positive and gonorrhea/chlamydia negative. Respiratory virus panel remained positive for COVID-19. HSV swab of lip lesion, HSV 1/2 IgG and IgM were negative. Mycoplasma pneumoniae IgG was elevated (0.60, negative is ≤0.09), IgM equivocal (0.85, negative is ≤0.76), and nasopharyngeal PCR negative. Conjunctival culture showed rare bacteria (S. Aureus) and no leukocytes. She initially received methylprednisolone IV due to concern for angioedema, acyclovir for empiric HSV treatment and empiric antibacterial moxifloxacin eye drops. Given lack of infectious trigger, her presentation was concerning for reactive infectious mucocutaneous eruption (RIME) associated with SARSCoV-2 or Mycoplasma. Prednisone 1mg/kg daily was initiated followed by improvement in oral mucositis and conjunctivitis within days. IMPACT/DISCUSSION: A broad differential is important when evaluating oral swelling and mucositis. Her lack of cutaneous involvement, medication exposure or family history and negative infectious, autoimmune and inflammatory workup make other causes including Stevens-Johnson syndrome, erythema multiforme, angioedema, and HSV less likely. Our final diagnosis of RIME describes mucocutaneous eruptions likely due to an immune response triggered by bacterial or viral infection. Our patient's RIME may be due to COVID-19 or Mycoplasma given her equivocal Mycoplasma IgM. Eruptions generally involve two or more mucosal sites and occur mostly in children and adolescents. Common presentations include oral erosions and ulcers, purulent bilateral conjunctivitis, or urogenital lesions, which were all seen in our patient. As this is a relatively rare and new condition, no standard of care treatment exists for RIME but systemic steroids have been effective in case reports for initial treatment and subsequent flares. CONCLUSION: RIME is a rare, newly described condition in young patients who develop postinfectious mucocutaneous eruptions of two or more mucosal sites. It has been recently reported in association with COVID-19 and its association with Mycoplasma infection is important to evaluate. This condition is important to recognize and treat given the requirement for higher dose steroids than that used for angioedema.

6.
Journal of General Internal Medicine ; 37:S362, 2022.
Article in English | EMBASE | ID: covidwho-1995661

ABSTRACT

CASE: Our patient is a 52-year-old female with a history of gastroesophageal reflux and hypertension. 36 hours after receiving the second Pfizer COVID-19 vaccine, she developed lip and tongue swelling, mucosal ulcerations, and respiratory distress. There was no conjunctivitis or genital involvement. She denied taking any new medications, supplements, or food that might have led to the reactions. She initially presented to an outside hospital and required intubation prior to transfer to our facility. A bedside esophagogastroduodenoscopy (EGD) was performed noting extensive Grade D erosive esophagitis and gastric ulcerations with friability. When the endoscope was removed a 34cm section of necrotic esophageal tissue was removed from the airway. Despite intravenous steroid treatment, she continued to have esophageal scarring and was unable to tolerate food by mouth. Therefore, a gastrostomy tube was placed. Since that time, she has required several recurrent EGDs for esophageal dilation due to scarring. It has now been six months from her initial injury, and unfortunately, the patient is still unable to take PO and is dependent on tube feedings. IMPACT/DISCUSSION: The coronavirus pandemic began in December 2019. At the time of this report, SARS-CoV-2 infection has been the cause of 5.48 million deaths worldwide and 836,000 deaths in the United States alone. In addition, this global pandemic has had severe economic and social implications. There are currently three vaccines authorized by the United States Food and Drug Administration for emergency use. I report an extremely uncommon complication of the Pfizer COVID-19 vaccine: a case of Eryethema Multiforme Major that occurred after the second dose vaccine without exposure to any other drug. Eryethema Multiforme is divided into major and minor forms and is regarded as distinct from Stevens- Johnson syndrome and toxic epidermal necrolysis. It is related to infections, usually Herpes Simplex Virus, or less commonly, to medications. In Erythema Multiforme, mucous membrane involvement is absent or mild. Erythema Multiforme Major is an immune mediated skin reaction involving the oral cavity and mucosa that is serious and occasionally life threatening. There have been several reported cases of Erythema Multiforme following COVID-19 vaccination but only one other cases of Erythema Multiforme Major associated with the mRnA-1273 SARS-CoV-2 vaccine (Moderna.) CONCLUSION: This case highlights an extremely rare vaccine consequence. The benefits still greatly outweigh the risks of vaccination, and this case does not diminish the importance of COVID-19 vaccination to effectively control this pandemic.

7.
Journal of Clinical Periodontology ; 49:84, 2022.
Article in English | EMBASE | ID: covidwho-1956753

ABSTRACT

The aim is to determine oral manifestations in patients with COVID-19 disease and in the postcovid period. Methods: A special survey (questionnaire) was made in 424 people who had COVID-19 confirmed by RT-PCR, ELISA for specific IgM and IgG antibodies and Chest CT scan (168 people). 123 people had complaints and clinical symptoms in the oral cavity 2-6 months after the illness and they came to the University dental clinic. Laboratory tests have been performed (clinical blood test, blood immunogram, virus and fungal identification). Results: Survey results showed that 16,0% participants had asymptomatic COVID-19, 23,6% - mild and 48,1% moderate disease. 12,3% with severe COVID-19 were treated in a hospital with oxygen support. In the first 2 weeks 44,3% indicated xerostomia, dysgeusia (21,7%), muscle pain during chewing (11,3%), pain during swallowing (30,2%), burning and painful tongue (1,9%), tongue swelling (30,2%), catharal stomatitis (16,0%), gingival bleeding (22,6%), painful ulcers (aphthae) (8,5%) and signs of candidiasis - white plaque in the tongue (12,3%). After illness (3-6 months), patients indicated dry mouth (12,3%), progressing of gingivitis (20,7%) and periodontitis (11,3%). In patients who applied to the clinic we identified such diagnoses: desquamative glossitis - 16 cases, glossodynia (11), herpes labialis and recurrent herpetic gingivostomatitis (27), hairy leukoplakia (1), recurrent aphthous stomatitis (22), aphthosis Sutton (4), necrotising ulcerative gingivitis (13), oral candidiasis (14), erythema multiforme (8), Stevens-Johnson syndrome (2), oral squamous cell papillomas on the gingiva (4) and the lower lip (1). According to laboratory studies, virus reactivation (HSV, VZV, EBV, CMV, Papilloma viruces) was noted in 52 patients (42,3%), immunodeficiency in 96 people (78,0%), immunoregulation disorders (allergic and autoimmune reactions) in 24 people (19,5%). Conclusions: Lack of oral hygiene, hyposalivation, vascular compromise, stress, immunodeficiency and reactivation of persistent viral and fungal infections in patients with COVID-19 disease are risk factors for progression of periodontal and oral mucosal diseases.

8.
British Journal of Dermatology ; 186(6):e253, 2022.
Article in English | EMBASE | ID: covidwho-1956715

ABSTRACT

A 24-year-old man presented with a 7-day history of oral ulceration and 3-day history of erythema at the urethral meatus with one erythematous papule on the scrotum. The patient had tested positive for COVID-19 on polymerase chain reaction test. The patient had not eaten for 6 days, managing only sips of water. There were no new medications and no recent vaccinations. On examination his lips were ulcerated with haemorrhagic crust. His tongue had significant swelling and ulceration. There was erythema and superficial ulceration surrounding the urethral meatus. Thus, the patient had mucosal involvement only, with no target lesions, blisters or epidermal detachment. Inflammatory markers were raised. The initial impression was that of reactive infectious mucocutaneous eruption (RIME) associated with COVID-19 infection, given the likely viral cause, in a systemically well, young patient. The differential included erythema multiforme major, Stevens-Johnson syndrome and pemphigus vulgaris. Bacterial and viral swabs, septic screen, sexually transmitted infection screen including HIV, circulating skin antibodies were all negative. The patient was treated with topical and systemic steroids, with a catheter to prevent urethral stenosis, intravenous Pabrinex®, oral nutritional supplements, analgesia, Difflam™ mouthwash, betamethasone mouth rinse and lidocaine mouth spray. The patient's symptoms had resolved after 6 weeks. This case demonstrates the multispecialty management of a patient presenting acutely with RIME secondary to COVID-19, who was treated successfully with oral and topical steroids.

9.
British Journal of Dermatology ; 186(6):e255, 2022.
Article in English | EMBASE | ID: covidwho-1956699

ABSTRACT

A 13-year-old boy presented with oral pain and mucositis on a background of preceding sore throat, fever and malaise. His lips were swollen and ulcerated with tonsillar exudate visible. Reverse transcriptase polymerase chain reaction testing for SARS-CoV-2 was positive, and inflammatory markers were raised (C-reactive protein 77 mg L-1, erythrocyte sedimentation rate 31 mm h-1);additional virology (herpes simplex virus, cytomegalovirus, Epstein-Barr virus and HIV) was negative. Intravenous fluids, ceftriaxone, acyclovir and analgesia including morphine were commenced. He was unable to tolerate soluble oral steroid rinses. Over 24 h, his oral mucositis progressed with the additional development of conjunctival injection and nontargetoid, erythematous papules. A diagnosis of erythema multiforme (EM) major in conjunction with COVID-19 infection was made. His condition deteriorated with oral intubation required to maintain airway patency and deep sedation for pain control. During a 13-day paediatric intensive care admission he developed an extensive rash including ulceration of the external genitalia. There was marked ulceration of the trachea but fortunately tracheostomy was avoided. The patient has subsequently recovered well. A variety of cutaneous features, including EM, have been described in conjunction with COVID-19 infection. The incidence of distinct rashes varies between adults and children with EM uncommon in both groups but seemingly more frequent in paediatric patients (Bennardo L, Nistoc®o SP, Dastoli S et al. Erythema multiforme and COVID-19: what do we know? Medicina (Kaunas) 2021;57: 828). The relationship of EM to outcome from COVID-19 infection itself is yet to be fully established. As with other infections, EM in children with COVID-19 exhibits a range of clinical presentations. This case highlights the severe end of the disease spectrum and underlines the role of the multidisciplinary team in management.

10.
J Dermatol ; 49(8): 769-774, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1816488

ABSTRACT

Despite poor evidence, the antiparasitic ivermectin has been advocated as a potential COVID-19 therapy. This has led to a rise in calls to poison-control centers by people self-medicating with ivermectin, which is sold over the counter for veterinary uses. We aimed to investigate the association between severe cutaneous adverse reactions (SCARs) and ivermectin. Postmarketing data from the FDA Adverse Event Reporting System (FAERS), gathered between 2014 and 2021, was employed to detect disproportional signals of SCARs following systemic ivermectin therapy. The reporting odds ratio (ROR) was used to quantify the strength of association, while adjusting for age, sex, and region. The search yielded 517 reports of systemic ivermectin (median age 54 years, 46.8% female), of which 25 (4.8%), 81 (15.7%), and 411 (79.5%) were classified as SCARs, nonsevere cutaneous adverse events (AEs), or noncutaneous AEs, respectively. The regional distribution differed between SCAR reports (32.0% from Africa and 12.0% from North America) compared with other AEs, which originated from North America in over half of cases. The most common SCARs were toxic epidermal necrolysis (seven cases), Stevens-Johnson syndrome (seven cases), and drug reaction with eosinophilia and systemic symptoms (four cases). Five SCAR cases (20.0%) resulted in death and 12 (48.0%) lead to hospitalization. There was a strong safety signal for any SCAR (adjusted ROR 3.34, 95% confidence interval [CI] 2.17-5.12) and toxidermias (adjusted ROR 7.08, 95% CI 4.23-11.84). This study suggests that ivermectin is associated with SCARs on rare occasions. Dermatologists should be aware of this given the increase in ivermectin misuse.


Subject(s)
COVID-19 , Stevens-Johnson Syndrome , Cicatrix , Female , Humans , Ivermectin/adverse effects , Male , Middle Aged , Pharmacovigilance
11.
J Curr Ophthalmol ; 34(1): 121-123, 2022.
Article in English | MEDLINE | ID: covidwho-1810846

ABSTRACT

Purpose: To report a case of bilateral central retinal vein occlusion (CRVO) associated with coronavirus-19 (COVID-19) infection. Methods: A 43-year-old man presented to the emergency department with flu-like symptoms, severe erythema, a rash on his face, and respiratory distress. He was admitted to the intensive care unit, and the reverse transcriptase-polymerase chain reaction test was positive for the severe acute respiratory syndrome coronavirus-2 virus. The routine blood work was unremarkable. The dermatologist noted positive Nikolsky's sign, and the patient was diagnosed with Stevens-Johnson syndrome (SJS), which affected 18% of his body and was later confirmed by skin biopsy. Later, he reported worsening vision. Results: Ophthalmic examination and fundus fluorescein angiography showed bilateral CRVO. Despite best medical efforts, including treatment with systemic dexamethasone and remdesivir, the patient died on the 6 days of his hospitalization. Conclusion: This was a rare bilateral CRVO and SJS case in a young patient, probably caused by the COVID-19 infection.

12.
Pharmacopsychiatry ; 55(1):58-59, 2022.
Article in English | APA PsycInfo | ID: covidwho-1772391

ABSTRACT

This letter discusses a type IV hypersensitivity reaction to older antiepileptic drugs during and after recovery from COVID-19 infection. The authors' observational findings led to the hypothesis that type IV hypersensitivity reactions to older antiepileptic drugs such as Stevens-Johnson syndrome (SJS) toxic epidermal necrolysis (TEN) may be facilitated by the COVID-19-induced immune stimulation. If that is the case, clinicians should consider the COVID-19 an SJS-associated viral infection, especially when prescribing well-known SJS-associated drugs (e. g., older anticonvulsants). However, additional in vivo and in vitro studies are required to prove this hypothesis. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

13.
Dermatol Ther ; 35(5): e15416, 2022 05.
Article in English | MEDLINE | ID: covidwho-1723136

ABSTRACT

Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN), is a type of delayed hypersensitivity reaction that requires urgent medical intervention. In the COVID-19 era, COVID-19 vaccines are currently being widely administered and mucocutaneous adverse reactions following vaccination have been reported; however, severe cutaneous adverse reactions associated with COVID-19 vaccines including SJS/TEN, are extremely rare. Herein, we describe a case of COVID-19 vaccination induced TEN which developed 1 day after receiving the first dose of Sinopharm COVID-19 vaccine with favorable clinical outcome.


Subject(s)
COVID-19 , Stevens-Johnson Syndrome , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Humans , Skin , Stevens-Johnson Syndrome/diagnosis , Stevens-Johnson Syndrome/etiology , Vaccination
14.
Brazilian Journal of Infectious Diseases ; 26, 2022.
Article in English | EMBASE | ID: covidwho-1693863

ABSTRACT

A Síndrome de Steven-Johnson é uma reação adversa a drogas rara e grave, sendo ainda mais rara quando acontece após uma exposição à vacina. Relatamos neste texto um caso de reação alérgica classificada como Síndrome de Steven- Johnson após exposição a primeira dose da vacina contra COVID-19 fabricada pela AstraZeneca/Fiocruz. Paciente Feminina de 40 anos, sem comorbidades prévias, apresentou nos primeiros três dias da primeira dose da vacina quadro clínico progressivo, inicialmente com edema em região auricular à esquerda, e máculas em membros superiores, prosseguindo com disseminação ao restante do corpo, evoluindo com eritema polimorfo, lesões bolhosas em regiões de membros superiores, edema na palma das mãos, plantas dos pés, e acometimento de mucosa oral com lesões aftoides, sangramentos espontâneos, e exsudação. Em relação à etiologia medicamentosa, quando questionada, a paciente referiu uso crônico apenas de venlanfaxina e informou que fez uso de dexametasona 4mg/dia, durante 2 meses, para quadro articular de arbovirose, suspendendo sem desmame, no final de junho/2021. Visando descartar atividade e influência de infecções virais, foram coletados exames sorológicos, com resultados negativos. Inicialmente, foi levantada hipótese diagnóstica de eritema polimorfo Major, mas histopatológico foi sugestivo de Síndrome de Stevens-Johnson (SSJ), caracterizada por reação de hipersensibilidade tardia com depósito do complemento e imunoglobulina (IgG) na junção dermo-epidérmica e em torno dos pequenos vasos da derme, progredindo para necrose da epiderme. Apesar de a patologia apresentar regressão espontânea, o tratamento no início do quadro, com suporte clínico adequado é essencial para o melhor prognóstico do paciente.

15.
Exp Ther Med ; 23(4): 257, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1690123

ABSTRACT

The novel coronavirus infection has been, and still is, a pressing medical problem with a catastrophic effect, not only from a medical point of view, but also from an economic and social one. The cutaneous manifestations of the disease have a diverse morphology and can signal the presence of the infection. The present article reports the case of a 77-year-old male patient admitted at The Sf. Parascheva Clinical Hospital of Infectious Diseases in Iasi (Romania) after testing positive for SARS CoV-2 infection. Initially, the patient presented a pruriginous generalized maculopapular-erythematous eruption with a tendency towards confluence, peri-oro-nasal meliceric crusts and desquamation of the skin on the third anterosuperior and posterior thorax, scalp and forehead, which was accompanied by low back pain, headache and orbital pain. The suspicion of Stevens-Johnson syndrome (SJS) was raised, and treatment was given according to the recommendation of the hospital dermatologist. This association raises multiple questions regarding whether SJS is a cutaneous manifestation of COVID-19 or if there was a concomitance between the viral infection and the immune reaction. The combination of SJS and COVID-19 can have a fatal outcome if not recognized and promptly treated. To our knowledge, this is the first case of SJS in a patient diagnosed with SARS CoV-2 infection in Romania.

17.
Allergy: European Journal of Allergy and Clinical Immunology ; 76(SUPPL 110):291, 2021.
Article in English | EMBASE | ID: covidwho-1570345

ABSTRACT

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease with a multiple organs-involvement. SLE pathogenesis is sustained by innate and adaptive immune system disregulation, complement activation, immune complexes, and tissue inflammation. The pattern of clinical manifestations is heterogenous and changes over time. Hydroxychloroquine (HCQ)is a primary drug in the treatment of SLE. It modulates the immune response by inhibiting B cell receptor and TLR signaling and activation. Clinical Case: This is a case report of a 61-years-old female affected by SLE with recurrent oral aftosis, Lupus anti-coagulant antibodies and previous pleuritis in remission. The patient had a long course treatment with low-dose oral corticosteroids (5 mg prednisone) and HCQ for three weeks. After 20 days of treatment with HCQ she developed an abrupt cutaneous manifestation consisting in painful and infiltrating papules which appeared over the upper trunk and limbs, redness, scales lesions on palms and soles, lip swelling, painful conjunctivitis and mild disphagia. Slowly, progressive improvement of cutaneous and mucosal signs was observed after drug discontinuation, two days after appearance of clinical manifestations, and introducing medium-high dose of oral corticosteroids therapy. Results: Clinical exams, performed in the acute phase highlighted a marked lymphocyto penia and raise of Reactive C Protein (RCP). Nicolsky sign was slightly positive. After discontinuation of HCQ the patient did not show cutaneous or infective sequelae due to prompt identification of Steven-Johnson Syndrome (SJS). The patient replaced HCQ with the increase of the mainteinance dose of oral corticosteroids. Skin tests were not perfomed for the risk of SJS exacerbation and concomitant corticosteroids therapy. Conclusions: Like all medications, HCQ has side effects which may occur in autoimmune disease patients. The main undesirable effects observed are digestive disorders and skin manifestations. Although skin diseases are common side effects of HCQ severe drug hypersensitivity reaction is a rare condition described in few case reports of DRESS and SJS. Despite the rare occurrence of these reactions, we observed other cases of drug reactions during the pandemic breakthrough in Italy when HCQ was widely used for the treatment of COVID-19.

18.
Clin Case Rep ; 9(11): e05099, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1530120

ABSTRACT

As public COVID-19 vaccination programs are being implemented, it is possible that more rare and serious adverse effects such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrosis (TEN) may occur.

19.
J Am Acad Dermatol ; 86(1): 113-121, 2022 01.
Article in English | MEDLINE | ID: covidwho-1401554

ABSTRACT

BACKGROUND: Cutaneous reactions after COVID-19 vaccination have been commonly reported; however, histopathologic features and clinical correlations have not been well characterized. METHODS: We evaluated for a history of skin biopsy all reports of reactions associated with COVID-19 vaccination identified in an international registry. When histopathology reports were available, we categorized them by reaction patterns. RESULTS: Of 803 vaccine reactions reported, 58 (7%) cases had biopsy reports available for review. The most common histopathologic reaction pattern was spongiotic dermatitis, which clinically ranged from robust papules with overlying crust, to pityriasis rosea-like eruptions, to pink papules with fine scale. We propose the acronym "V-REPP" (vaccine-related eruption of papules and plaques) for this spectrum. Other clinical patterns included bullous pemphigoid-like (n = 12), dermal hypersensitivity (n = 4), herpes zoster (n = 4), lichen planus-like (n = 4), pernio (n = 3), urticarial (n = 2), neutrophilic dermatosis (n = 2), leukocytoclastic vasculitis (n = 2), morbilliform (n = 2), delayed large local reactions (n = 2), erythromelalgia (n = 1), and other (n = 5). LIMITATIONS: Cases in which histopathology was available represented a minority of registry entries. Analysis of registry data cannot measure incidence. CONCLUSION: Clinical and histopathologic correlation allowed for categorization of cutaneous reactions to the COVID-19 vaccine. We propose defining a subset of vaccine-related eruption of papules and plaques, as well as 12 other patterns, following COVID-19 vaccination.


Subject(s)
COVID-19 Vaccines/adverse effects , COVID-19 , Exanthema , Skin Diseases/chemically induced , COVID-19/prevention & control , Exanthema/chemically induced , Humans , Registries
20.
Cureus ; 13(8): e17215, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1372150

ABSTRACT

Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a spectrum of acute, delayed-type hypersensitivity reactions that affect the skin and the mucous membranes. Medications are the culprit cause of these disorders in addition to infections and in very rare instances vaccinations. We report a case of TEN in a 49-year-old woman with no previous medical history. The disorder developed one week after receiving the first dose of COVID-19 vaccine with no other identifiable causes. The patient received two doses of tumor necrosis factor-alpha inhibitor (etanercept) and she stopped developing new lesions after two days of the initial dose; complete healing was observed after 22 days and no side effects were observed in our patient. This case demonstrates an extremely rare complication to the COVID-19 vaccine. The benefits of receiving the COVID-19 outweigh the potential risk.

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