Bullous pemphigoid onset following Pfizer-BioNTech COVID-19 vaccine (COMIRNATY®): coincidence or a new emerging adverse effect?

ABSTRACT

We report the case of a 61-year-old man referred to the dermatology clinic with a new onset of itchy rash with blisters within 2 weeks following the first dose of the Pfizer-BioNTech COVID-19 vaccine (COMIRNATY®). After the second dose of the same vaccine within 72 h, he developed a widespread rash with tense blisters with oral mucosal involvement. His medical history included obesity (body mass index 47.8 kg m-2), type 2 diabetes mellitus, hypertension and hypothyroidism. His regular medications included alogliptin (established for 3 years) and levothyroxine. There were no recent changes or additions to his drugs reported. On examination, he had extensive erythematous plaques with tense bullae and oral ulcers. Skin anti-epi basement membrane antibodies were positive, and anti-epidermal intercellular antibodies were negative. We considered the diagnosis of bullous pemphigoid (BP) on the clinical picture and indirect immunofluorescence studies. Topical treatment started with 50 50 white soft paraffin, clobetasol propionate ointment and systemic oral prednisolone with doxycycline with reasonable disease control within 4 weeks. We were faced with a diagnostic conundrum. We postulated two possibilities new-onset BP coincidental and unrelated to vaccination or BP secondary to the vaccine as suggested by the time-dose relationship. As the patient was established on alogliptin for 3 years, we considered it unlikely this drug had contributed to the disease onset. Case reports are now emerging of BP following vaccination with other COVID- 19 vaccines. This phenomenon has implications for future inoculation with the booster vaccine, requiring careful consideration and discussion with our patients. This case is registered on the Yellow Card scheme (Pérez-López I, Moyano- Bueno D, Ruiz-Villaverde R. Bullous pemphigoid and COVID-19 vaccine. Med Clin (Engl Ed) 2021;157 e333-4;Agharbi F, Eljazouly M, Basri G et al. Bullous pemphigoid induced by the AstraZeneca COVID-19 vaccine. Ann Dermatol Venereol 2022;149 56-7).