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
AUTHORS (6)
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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