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J Dermatol ; 50(2): 162-165, 2023 Feb.
Article in English | MEDLINE | ID: covidwho-2192133


Bullous systemic lupus erythematosus (BSLE) is a rare blistering disease in patients with SLE. BSLE is a heterogenous disease caused by autoantibodies to the basement membrane, mainly type VII collagen. The pathogenesis of the development of autoantibodies in BSLE remains unknown. We report a case of SLE taking dipeptidyl peptidase 4 inhibitors (DPP4i) who developed tense blister lesions after administration of SARS-CoV-2 vaccine. Initial erythematous lesion before administration of SARS-CoV-2 vaccine had not shown IgG deposition at basement membrane both direct and indirect immunofluorescence (IIF). However, the result of those examinations became positive after the administration of SARS-CoV-2 vaccine. Furthermore, IIF test results using NaCl split skin had shown positive against epidermal side. These observations suggest that SARS-CoV-2 vaccination triggered production of autoantibodies that cause bullous SLE. The present case fulfills the diagnostic criteria for both BSLE and DPP4i-associated bullous pemphigoid. Skin lesions were cleared after withdrawal of DPP4i. Therefore, physicians should ask patients who develop blisters after the vaccination whether they are taking DPP4i.

COVID-19 Vaccines , COVID-19 , Dipeptidyl-Peptidase IV Inhibitors , Lupus Erythematosus, Cutaneous , Lupus Erythematosus, Systemic , Pemphigoid, Bullous , Humans , Autoantibodies , Blister/pathology , COVID-19/diagnosis , COVID-19/prevention & control , COVID-19/complications , COVID-19 Vaccines/adverse effects , Dipeptidyl-Peptidase IV Inhibitors/adverse effects , Lupus Erythematosus, Systemic/diagnosis , Lupus Erythematosus, Systemic/drug therapy , Pemphigoid, Bullous/chemically induced , Pemphigoid, Bullous/diagnosis , Pemphigoid, Bullous/complications , SARS-CoV-2
J Cutan Pathol ; 49(1): 34-41, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1320386


BACKGROUND: As more people become vaccinated against the SARS-CoV-2 virus, reports of delayed cutaneous hypersensitivity reactions are beginning to emerge. METHODS: In this IRB-approved retrospective case series, biopsy specimens of potential cutaneous adverse reactions from the Pfizer-BioNTech or Moderna mRNA vaccine were identified and reviewed. Clinical information was obtained through the requisition form, referring clinician, or medical chart review. RESULTS: Twelve cases were included. Histopathological features from two injection-site reactions showed a mixed-cell infiltrate with eosinophils and a spongiotic dermatitis with eosinophils. Three biopsy specimens came from generalized eruptions that showed interface changes consistent with an exanthematous drug reaction. Three biopsy specimens revealed a predominantly spongiotic pattern, consistent with eczematous dermatitis. Small-vessel vascular injury was seen in two specimens, which were diagnosed as urticarial vasculitis and leukocytoclastic vasculitis, respectively. There were two cases of new-onset bullous pemphigoid supported by histopathological examination and direct immunofluorescence studies. Eosinophils were seen in 10 cases. CONCLUSIONS: Dermatopathologists should be aware of potential cutaneous adverse reactions to mRNA-based COVID-19 vaccines. Histopathological patterns include mixed-cell infiltrates, epidermal spongiosis, and interface changes. Eosinophils are a common finding but are not always present. Direct immunofluorescence studies may be helpful for immune-mediated cutaneous presentations such as vasculitis or bullous pemphigoid.

COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Drug-Related Side Effects and Adverse Reactions/pathology , Hypersensitivity, Delayed/pathology , 2019-nCoV Vaccine mRNA-1273/adverse effects , Adult , Aged , Aged, 80 and over , BNT162 Vaccine/adverse effects , Biopsy/methods , COVID-19/diagnosis , COVID-19/immunology , COVID-19/virology , Dermatitis/etiology , Dermatitis/pathology , Drug-Related Side Effects and Adverse Reactions/etiology , Eosinophils/pathology , Female , Fluorescent Antibody Technique, Direct/methods , Humans , Hypersensitivity, Delayed/etiology , Male , Middle Aged , Pemphigoid, Bullous/diagnosis , Pemphigoid, Bullous/pathology , Retrospective Studies , SARS-CoV-2/genetics , SARS-CoV-2/immunology , Skin/pathology , Vasculitis/chemically induced , Vasculitis/pathology