Kong Joyce, Cuevas-Castillo Francisco, Nassar Mahmoud, Lei Chi M, Idrees Zarwa, Fix William C, Halverstam Caroline, Mir Adnan, Elbendary Amira, Mathew Alwin
Icahn School of Medicine at Mount Sinai/NYC Health + Hospitals Queens, NY, USA.
Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA.
J Infect Public Health. 2021 Oct;14(10):1392-1394. doi: 10.1016/j.jiph.2021.06.021. Epub 2021 Jul 8.
In December 2020, Moderna released the mRNA-1273 vaccine. The most common side effects are headache, muscle pain, redness, swelling, and tenderness at the injection site. In addition, there have been dermatological adverse events, such as hypersensitivity reactions. Although rare, various bullous eruptions have been described following vaccination. Bullous pemphigoid has been reported to occur most often after receipt of influenza and the diphtheria-tetanus-pertussis vaccine. To the best of our knowledge, there have been no reports of bullous drug eruptions resulting from mRNA vaccines.
A 66-years-old obese Guyanese male presented with a bullous rash following receipt of a commercial COVID-19 mRNA vaccine. He received the first dose uneventfully. However, within 24 h of receiving the second dose, he developed fever, myalgias, and malaise accompanied by a painful blistering rash of his torso, arms, and legs. His fever and myalgias improved after 24 h, but his painful rash did not, and five days after the initial symptoms, he presented to the hospital. There were many violaceous, poorly demarcated patches on his trunk, arms, and thighs on examination, many of which had large flaccid bullae within, and a few areas on his buttocks, posterior shoulder, and scrotum were eroded. The exam was also significant for lower extremity muscle tenderness, stiffness with preserved strength. A skin biopsy showed epidermal necrosis and sparse perivascular dermatitis concerning Stevens-Johnson syndrome or erythema multiforme. However, in the absence of mucous membrane involvement or targetoid lesions, the diagnosis of an extensive bullous fixed drug eruption was made.
This case illustrates that the bullae eruption occurred as a result of receiving the Moderna vaccination.
2020年12月，莫德纳公司发布了mRNA-1273疫苗。最常见的副作用是头痛、肌肉疼痛、注射部位发红、肿胀和压痛。此外，还出现了皮肤不良事件，如过敏反应。虽然罕见，但接种疫苗后出现了各种大疱性皮疹。据报道，大疱性类天疱疮最常发生在接种流感疫苗和白喉-破伤风-百日咳疫苗之后。据我们所知，尚无mRNA疫苗导致大疱性药疹的报道。
一名66岁的肥胖圭亚那男性在接种商用COVID-19 mRNA疫苗后出现大疱性皮疹。他接种第一剂时没有出现问题。然而，在接种第二剂后的24小时内，他出现了发热、肌痛和不适，并伴有躯干、手臂和腿部疼痛的水疱性皮疹。24小时后他的发热和肌痛有所改善，但疼痛的皮疹没有改善，在出现初始症状五天后，他前往医院就诊。检查发现他的躯干、手臂和大腿上有许多紫罗兰色、边界不清的斑块，其中许多有大的松弛水疱，他的臀部、后肩部和阴囊的一些部位有糜烂。检查还发现下肢肌肉压痛、僵硬但力量保留。皮肤活检显示表皮坏死和稀疏的血管周围性皮炎，提示史蒂文斯-约翰逊综合征或多形红斑。然而，由于没有黏膜受累或靶形损害，诊断为广泛的大疱性固定性药疹。
本病例表明，大疱性皮疹是接种莫德纳疫苗所致。
