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Reactive infectious mucocutaneous eruption (RIME) is a mucosal-predominant eruption that usually affects two or more mucosal sites. We present a case of RIME secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and provide a brief review of the literature with a focus on the natural history and response to treatment. This entity may require inpatient management and systemic corticosteroids for symptom control in the pediatric population.
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The COVID-19 pandemic has posed many challenges to the medical community, a number of which will remain in the near future. Analysis of clinical cases helps to identify problems, to plan future research, which can change the understanding of the consequences of the disease. As the first year of the pandemic progresses, there is a better understanding of the pathophysiology of the virus and the varied results of imaging COVID-19 in affected organs, which is crucial for improving the treatment of this complex disease and improving health outcomes. It is described a clinical case of exanthema in an 11-year-old patient after COVID-19 Clinical and immunological methods of investigation are used. The child's condition was of the moderate severity, caused by skin and asthenovegetative syndromes. The child was diagnosed with COVID-19;fatigue syndrome after a viral illness;post COVID-19 exanthema infection crustal ichthyosis of the legs. A particular feature of this case is the occurrence of exanthema on the skin of the child after COVID-19. In these cases, the awareness of pediatricians should be raised to increase the level of knowledge of the correct diagnostic algorithm. © 2022 by the Author(s).
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SARS-CoV-2 infection can manifest many rashes. However, thrombotic retiform purpura rarely occurs during COVID-19 illness. Aggressive anti-COVID-19 therapy with a high-dose steroid regimen led to rapid recovery. This immunothrombotic phenomenon likely represents a poor type 1 interferon response and complement activation on the endothelial surface in response to acute infection.
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We report a case of a 19-year-old female with multisystemic inflammatory syndrome that was associated with the novel coronavirs disease 2019 (COVID-19), which manifested as serious illness that occurred four weeks after COVID-19 infection. Her clinical manifestations involved multiple organ systems including high-grade fever with shock syndrome, pulmonary edema, myopericarditis with pericardial effusion, hepatitis, generalized maculopapular rash, and several elevated inflammatory markers. She was treated with human immunoglobulin, methylprednisolone, acetylsalicylic acid, enoxaparin, and empirical antibiotics. She required a 2-week hospitalization and was discharged after improvement of clinical symptoms and normalization of inflammatory markers. A day prior to discharge, an echocardiography was done and it showed normal ventricular function and no coronary aneurysmal dilation.
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The article reviews published data on skin manifestations of COVID-19 infection, summarizing experiences of the Department of Dermatovenereology. University Hospital Hradec Kralove with monitoring skin involvement in SARS-CoV-2 in January-July 2021. Suspected association between COVID-19 and skin involvement was found in 41 out of 50 examined patients. Clinical follow-up was performed at 2-month intervals. The most frequent post-COVID-19 skin complication was telogen effluvium in 33 cases, the vast majority of them (32 patients) being females. The association of skin symptoms in COVID-19 patients with direct effect of SARS-CoV-2 is also discussed. As-signing all types of skin exanthems to direct cytopathic effects of the virus is not appropriate. Histopathological correlations should be crucial in lesion differentiation and in understanding the pathogenic mechanisms associated with COVID-19 infection. The differential diagnosis of skin exanthems also includes drug sensitivity reactions. In the literature, there have been reports of increasing heterogeneity of skin lesions associated with SARS-CoV-2 infection. Therefore, categorization will be necessary to distinguish pathognomonic symptoms from non-specific consequences of systemic involvement in COVID-19 infection and from drug side effects used in its management. Correlation of clinical presentations and pathology will be critical to differentiate coincidence and causative correlation with COVID-19 infection. Tools used for such causative correlation consist of improved immunohistochemical methods, detection of SARS-CoV-2 RNA with RT-PCR assays and the use of electron microscopy.
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Introduction: Polyethylene glycol (PEG) is one of the ingredients in the Pfizer/BioNTech COVID 19 vaccine (mRNA vaccine) and has been known to cause hypersensitivity [1-3]. Polysorbate is an ingredient in the Johnson vaccine (adenovirus vaccine) which may crossreact with PEG. Objective: We report a case of cross-reactivity between Pfizer/ BioNTech and Johnsson vaccines. Methods: This observation was notified in the pharmacovigilance center of Sfax, Tunisia (faculty of medicine of Sfax). The study of drug imputability was carried out according to the WHO method. Results: We report the case of a 32-year-old Tunisian woman with a history of atopy and intolerance to non-steroidal anti-inflammatory drugs (NSAIDs) but no history of SARS-CoV-2 infection. On August 15, 2021 (at 08:30), she developed sweating, vomiting and dizziness immediately after receiving the initial dose of Johnson COVID-19 vaccine. Her blood pressure became lower (less than 90/60 mmHg). She had to stay at the vaccination centre for one hour, and the clinical signs improved spontaneously after one hour. In the evening of the same day, the patient presented a febrile maculopapular eruption in the abdomen, trunk, and face. The rash resolved spontaneously over a week. The patient was referred to the pharma-covigilance center of Sfax (Tunisia). The messenger RNA vaccine was advocated for the second vaccine. On December 2021, she was received the second dose of the Pfizer/BioNTech COVID 19 vaccine (mRNA vaccine). Six hours later, she experienced a pruritic maculopapular rash on the abdomen, trunk, neck, and face. These clinical signs improved spontaneously after two days. the diagnosis of cross-allergy between these two vaccines was retained for this patient Conclusion: To our knowledge, this is the first cross-allergy between mRNA and adenovirus COVID-19 vaccines notified in Tunisian population. Healthcare professionals should be aware that hypersen-sitivity can occur with COVID-19 vaccines containing macrogols/ PEGs and those containing polysorbates. Its recognition may be challenging and often require skin testing. Per CDC guidance, con-sultation with an allergist-pharmacologist should be considered to help determine if the patient can safely receive vaccination [4].
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Introduction: Pfizer/BioNTech (BNT162b2) and Oxford/AstraZeneca (chAdOx1-S) COVID-19 vaccines were approved for emergency use. Clinical trials of both vaccines reported no safety concerns other than a few local and systemic reactions that resolved in few days for both vaccines. Cutaneous reactions to COVID-19 vaccination are generally minor and self-limited. The most common cutaneous reaction reported was a local injection-site reaction. Objective: Here we present 3 cases of erythema multiform following COVID-19 vaccination with positive rechallenge in 2 cases. Methods: Not applicable. Results: Case 1: A 51 year old woman with no past medical history presented with a macular, erythematous, round-shaped itchy rash on the hands, knees and soles. She denied having a neither recent illness nor sick contact. However, she received the first dose of the mRNA Pfizer/BioNTech (BNT162b2), 3 days earlier. Lesions disappeared in 7 days with local corticosteroid treatment. One month later and two days after receiving the second shot of the same vaccine, lesions reappeared and extended to upper members. Skin biopsy was compatible with erythema polymorph. Case 2: A 55 year old man with a past medical history of hypertension, presented 6 days following the 2nd shot of the mRNA Pfizer/ BioNTech (BNT162b2), vesicular eruptions on the upper and lower members. The outcome was favorable within 2 weeks under local corticosteroid. The patient reported that he had the same skin lesions in ankles and soles few days following the 1st shot of the same vaccine. Histological findings revealed an erythema polymorph. Case 3: A 57 year old woman with a medical history of hypertension and anxiety disorder presented with a worsening rash and fever for 6 days. The patient reported that she experienced fever, polyarthralgia and that she had received the second shot of Oxford/AstraZeneca (chAdOx1-S), the day before these symptoms appeared. On the physical examination, she had targetoid skin lesions over the trunk, on the ear, upper and lower members. Otherwise she had oral and genital mucosal ulcerations. A thoracic CT scan was performed because of the persistent fever and showed multiple enlarged lymph nodes, a layer of pericardial and plural effusion. A favorable outcome was observed in 3 weeks. Conclusion: Erythema multiform remains an exceptional COVID 19 vaccine adverse effect. Health care workers must be aware of this potential adverse effect or its recurrence and advise patients accordingly. Benefits of receiving a COVID 19 vaccine remains more important.
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Common causes of viral exanthems in Australia include herpesviruses, enteroviruses, parvovirus B19, varicella, measles and rubella viruses and mosquito-borne alphaviruses. The cause can often be diagnosed clinically from the rash distribution and morphology, confirmed only when necessary with serological or PCR tests. Most viral exanthems are self-limiting, requiring supportive care alone.
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Objective: NA Background: Previous case reports have described 3 cases of autoimmune encephalitis and 1 case of new-onset refractory status epilepticus (NORSE) following COVID-19 viral vector vaccinations. However, no cases have been documented in association with COVID-19 mRNA vaccinations. We describe a case of NORSE after vaccination with Pfizer-BioNTech COVID-19 vaccine. Design/Methods: Case report. Results: A 56 year old healthy man presented with three days of fever, fatigue, and aphasia beginning 2 weeks after he received his first dose of the Pfizer-BioNTech COVID-19 vaccine. Video EEG showed temporally predominant seizures occurring independently bilaterally (right greater than left). Clinical seizures were characterized by head turn to the left and right hand movements. He then developed sustained right frontotemporal spike and slow wave activity consistent with non-convulsive status epilepticus. CSF demonstrated mild lymphocytic pleocytosis with WBC 16 cells/mm3, protein 24, glucose 76, and an opening pressure of 47. CSF bacterial and viral encephalitis panels, HSV, lyme, West Nile virus, and VDRL were all negative. Oligoclonal bands, paraneoplastic panel, and encephalopathy panel were negative. Systemic malignancy workup was negative. Initial MRI brain was unremarkable, but 1 week after symptom onset he developed bilateral hippocampal edema. The patient was empirically treated with broad spectrum antibiotics and antivirals which were later discontinued. Due to presumed diagnosis of autoimmune encephalitis, he was treated with high dose steroids, plasmapheresis, IVIG, and rituximab. He was treated with progressively escalating anti-seizure medications including midazolam, propofol, and ketamine continuous infusions and eventually stabilized on levetiracetam, lacosamide, phenobarbital, clobazam, zonisamide, oxcarbazepine, and perampanel. At the time of discharge, mental status had improved and aphasia resolved. Conclusions: To our knowledge, this is the first case of NORSE reported after Pfizer COVID-19 vaccination. While no test exists to definitively establish causality, these findings warrant further investigation of the possible association between COVID-19 vaccination and autoimmune encephalitis.
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We present the case of a 24-year-old Caucasian man, who developed a scaly erythematous skin rash after the second dose of coronavirus disease 2019 (COVID-19) vaccination with Comirnaty (BNT162b2, BioNTech/Pfizer; Pfizer, New York, NY, USA) and proved positive for Epstein-Barr virus (EBV) reactivation. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccines have been associated with an up-regulated T helper type 1-cell response, possibly favoring an immune system imbalance. Also, EBV reactivation has been postulated after COVID-19 vaccination, but only in the immunosuppressed. Noteworthy we report the first case of EBV viral reactivation associated with cutaneous manifestations in an immunocompetent patient after the COVID-19 vaccine.
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RESUMEN Introducción. En 2019 surgió el coronavirus SARS-CoV-2, causante del COVID-19, ocasionando una pandemia que se extendió rápidamente alrededor del mundo;en casos graves, este, puede desencadenar un síndrome de tormenta de citoquinas, y conllevar a la muerte. Las manifestaciones cutáneas pueden asociarse a la expresión del receptor ACE2 en queratinocitos, estas, se han descrito en la literatura de diversos países. La presente revisión busca documentar las presentaciones cutáneas que se han descrito en pacientes con COVID-19 en América Latina. Metodología. Realizamos una búsqueda en nueve bases de datos de artículos en español, portugués e inglés, hasta el 10 de marzo del 2021, utilizando los términos: «Skin», «Cutaneous manifestations», «COVID 19», «SARS-COV-2», asociándolos al nombre de los países Latinoamericanos. Se obtuvieron los datos básicos de los pacientes incluidos, luego se creó una tabla en Microsoft Excel para analizar y comparar datos. Resultados. Se identificaron 22 publicaciones de nueve países. Obtuvimos información de 92 pacientes, predominantemente de sexo femenino y edad promedio de 31,6 años. Fueron documentadas 99 lesiones dermatológicas, en orden de frecuencia correspondieron a rash, habones, petequias-púrpura y pápulas. En 70 pacientes se describió el segmento corporal afectado, principalmente el tronco, miembros inferiores y superiores. Encontramos 39 fotografías y 5 histopatologías. Los tratamientos más formulados fueron corticoides, antipalúdicos e interferón recombinante. Conclusiones. Se observan diferencias en las manifestaciones cutáneas del COVID-19, entre las publicaciones latinoamericanas respecto a los demás países. Parece haber un patrón propio, donde predomina el rash eritematoso con habones, mientras que la pseudo-perniosis fue menos representativa. Introduction In 2019, the SARS-CoV-2 coronavirus emerged, producing COVID-19, which caused a pandemic that spread rapidly around the world;in severe cases, it can trigger cytokine storm syndrome and lead to death. Cutaneous manifestations can be associated with the expression of the ACE2 receptor in keratinocytes, these have been described in the literature from different countries. This review seeks to document the skin presentations that have been described in patients with COVID-19 in Latin America. Methodology. We researched in nine databases for articles in Spanish, Portuguese and English, until March 10, 2021, using the terms: “Skin”, “Cutaneous manifestations”, “COVID-19”, “SARS-COV-2”, associating them with Latin American countries. Basic data was obtained from the patients, then a table was created in Microsoft Excel to analyze and compare this data. Results 22 publications from nine countries were identified. We obtained information from 92 patients, predominantly female with an average age of 31.6 years. 99 dermatologic lesions were documented, in order of frequency: rash, wheals, petechiae-purpura and papules. In 70 patients the affected body segment was described, mainly the trunk, lower and upper limbs. We found 39 photographs and 5 histopathologies. The most indicated treatments were corticosteroids, antimalarials and recombinant interferon. Conclusions Differences can be observed in the description of cutaneous manifestations caused by COVID-19, between Latin American publications and the ones found in other countries. There seems to be a specific pattern with a predominance of erythematous rash with wheals, while pseudo-perniosis was less representative.
Subject(s)
COVID-19 , Skin Diseases , Consensus , Humans , Mouth Mucosa , Pandemics , Prospective Studies , SARS-CoV-2 , SpainABSTRACT
The diagnosis of coronavirus disease (COVID-19) has been a great challenge since the infection affects not only the respiratory system, but also different organs, given the intense inflammatory and autoimmune reaction triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Herein we present a case of a 36-year-old male patient, with some comorbidities and previous use of carbamazepine, who developed a severe condition triggered by COVID-19, including extensive exfoliative erythroderma and severe impairment of liver function, which lasted approximately 80 days.
Subject(s)
COVID-19 , Drug Hypersensitivity Syndrome , Eosinophilia , Exanthema , Adult , Antigen-Antibody Complex , COVID-19/complications , Drug Hypersensitivity Syndrome/diagnosis , Drug Hypersensitivity Syndrome/etiology , Humans , Male , SARS-CoV-2ABSTRACT
Numerous vaccines are under clinical development and implementation for the prevention of severe course and lethal outcomes of coronavirus disease 2019 (COVID-19). This systematic review aims to summarize and integrated the findings of studies regarding cutaneous side effects of COVID-19 vaccines. This systematic review conducted by searching the scientific databases of PubMed, Scopus, Science direct, and Web of knowledge from the beginning of the COVID-19 to May 10, 2021. Articles were reviewed and analyzed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Seventeen studies on cutaneous side effects of COVID-19 vaccines were included after the screening of search results based on to the eligibility criteria. The results showed that the most common injection site reactions and delayed large local reactions, arising from all vaccine types, were redness/erythema (39%), followed by: itchiness (28%), urticarial rash (17%) on the neck, upper limbs, and trunk, morbilliform eruptions (6.5%), Pityriasis rosea (3%), swelling, and burning, and so forth. Most cutaneous reactions occurred in women (84%), and middle-aged people, after the first dose of vaccine, with the onset ranged from 1 to 21 days after vaccination. In addition, cutaneous reactions were generally self-limiting, and needed little or no therapeutic intervention, that were not regarded as a barrier to injecting a second dose. In conclusion, severe cutaneous side effects are very rare and approved vaccines have satisfactory safety profiles. Therefore, mild or moderate cutaneous reactions should not discourage people from vaccination. In certain groups such as patients with allergies and a history of local injection reactions, pre-vaccination counseling and assurance, also use of appropriate medications may be helpful. However, more studies are needed to investigate the side effect profile of all COVID-19 vaccines.
Subject(s)
COVID-19 , Drug-Related Side Effects and Adverse Reactions , Vaccines , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Drug-Related Side Effects and Adverse Reactions/etiology , Female , Humans , Middle Aged , Skin , Vaccination/adverse effectsABSTRACT
The ongoing COVID-19 pandemic, declared by the World Health Organisation in March 2020, with the emergence of new, possibly more contagious and more virulent strains, remains a research subject, with the complex systemic involvement better described and understood, but also with a variety of skin and mucosal lesions described in the literature. Mucocutaneous lesions associated with SARS-CoV-2 infection are still under investigation, due to their polymorphic clinical aspect and incompletely understood pathogenic mechanism. The cutaneous inflammatory, exanthematous and purpuric rashes, erythemato-purpuric enanthems, oral ulcers, lichenoid oral lesions, conjunctivitis, conjunctival pseudomembranes, or corneal lesions have been described in patients with COVID-19. Several classifications have been proposed based on the clinical pattern, histological findings, and possible pathogenic mechanisms. The pathogenic mechanism, the diagnostic criteria, the prognostic importance of these lesions are still being debated. The diverse clinical aspects of dermatological manifestations render the diagnosis difficult. However, several clinical patterns strongly associated with COVID-19, such as chilblains, papulovesicular exanthems, and febrile rash require increased awareness and changes to the investigation protocols for these conditions, to include testing for SARS-CoV-2. In the present review, the mucocutaneous findings associated with the novel coronavirus infection, reported thus far in the literature, was provided.