Clinical and histopathological spectrum of delayed adverse cutaneous reactions following COVID‐19 vaccination

Adult Aged, 80 and over Male COVID-19 Vaccines Drug-Related Side Effects and Adverse Reactions SARS-CoV-2 Biopsy COVID-19 Dermatitis Middle Aged 3. Good health Eosinophils 03 medical and health sciences 0302 clinical medicine Fluorescent Antibody Technique, Direct Pemphigoid, Bullous Humans Female Hypersensitivity, Delayed BNT162 Vaccine 2019-nCoV Vaccine mRNA-1273 Aged Retrospective Studies
DOI: 10.1111/cup.14104 Publication Date: 2021-07-22T15:25:47Z
ABSTRACT
AbstractBackgroundAs more people become vaccinated against the SARS‐CoV‐2 virus, reports of delayed cutaneous hypersensitivity reactions are beginning to emerge.MethodsIn 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.ResultsTwelve 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.ConclusionsDermatopathologists 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.
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