Nida Syeda S, Tobon Gabriel J, Wilson Morgan, Chauhan Krati
Internal Medicine, Southern Illinois University School of Medicine, Springfield, USA.
Internal Medicine, Rheumatology, Southern Illinois University School of Medicine, Springfield, USA.
Cureus. 2022 Sep 30;14(9):e29786. doi: 10.7759/cureus.29786. eCollection 2022 Sep.
Our knowledge about the clinical spectrum of COVID-19 has continued to evolve. The clinical features of the infection and vaccine are continuously updated. We present a case of bullous pemphigoid after receiving a second dose of the COVID-19 vaccine. This case highlights autoimmune skin findings seen in a patient after COVID-19 vaccination. A 70-year-old male presented with the chief complaint of blistering skin rash. He received his second dose of Pfizer COVID-19 vaccine two days before developing a painful pruritic maculopapular rash that started on his hands and extended proximally to his trunk. Physical exam was remarkable for tense bullae with negative Nikolsky sign. Biopsy and direct immunofluorescence lead to the diagnosis of bullous pemphigoid. The lesions improved significantly with steroids. Various cutaneous eruptions have been reported with Moderna and Pfizer COVID-19 vaccines, including the new onset of bullous pemphigoid. Based on our case, we suggest that bullous pemphigoid after COVID-19 vaccination is responsive to steroids and the prognosis is excellent. Understanding the clinical course and prognosis of bullous pemphigoid from the COVID-19 vaccine is of significant importance as we strive to keep our patients and communities safe. More data is needed to better guide recommendations, but so far looking at the example from our case, the benefits of COVID-19 vaccination seem to outweigh the risks. Therefore, patients should be advised to continue with future vaccinations.
我们对新冠病毒病（COVID-19）临床谱的认识一直在不断发展。该感染及疫苗的临床特征也在持续更新。我们报告一例在接种第二剂COVID-19疫苗后发生大疱性类天疱疮的病例。此病例突出了COVID-19疫苗接种后患者出现的自身免疫性皮肤表现。一名70岁男性，以皮肤水疱性皮疹为主诉就诊。他在出现始于手部并向近端蔓延至躯干的疼痛性瘙痒性斑丘疹前两天接种了第二剂辉瑞COVID-19疫苗。体格检查发现有紧张性大疱，Nikolsky征阴性。活检及直接免疫荧光检查确诊为大疱性类天疱疮。使用类固醇治疗后皮损明显改善。已报道Moderna和辉瑞COVID-19疫苗会引发各种皮肤疹，包括新发的大疱性类天疱疮。基于我们的病例，我们认为COVID-19疫苗接种后发生的大疱性类天疱疮对类固醇治疗有反应，预后良好。在我们努力保障患者和社区安全的过程中，了解COVID-19疫苗所致大疱性类天疱疮的临床病程及预后至关重要。需要更多数据来更好地指导相关建议，但就目前我们病例的情况来看，COVID-19疫苗接种的益处似乎大于风险。因此，应建议患者继续进行后续疫苗接种。
