Wali Sachin, Gutte Shreyas, Pandey Gaurav, Kumar Ajit, Gurjar Mohan, Chahar Jitendra Singh
Sanjay Gandhi Postgraduate Institute of Medical Sciences Department of Critical Care Medicine Lucknow India.
Command Hospital Air Force Department of Anaesthesiology and Critical Care Bengaluru India.
J Acute Med. 2024 Jun 1;14(2):94-97. doi: 10.6705/j.jacme.202406_14(2).0005.
Following vaccination for COVID-19, various cutaneous adverse reactions (CARs) are reported. Here is an Asian male in late 50's who developed necrotic skin with mucosal involvement 10 days following booster dose of ChAdOx1 nCov-19 vaccination. Based on disease course and morphology, toxic epidermal necrolysis (TEN) was suspected. The patient developed respiratory distress and was intubated, intravenous immunoglobulin (IVIG) administered at 2 g/kg body weight following which skin lesions healed in fourth week, the patient was discharged after 50 days of intensive care unit (ICU) stay. Severe CARs are rare following vaccination, of two components in ChAdOx1nCoV-19 adenoviral vector vaccine, virotopes cause T-cell mediated granulysin and granzyme B release leading to epidermal detachment and mucosal involvement of conducting airways causing respiratory failure. CARs can also occur in whom first and second dose was uneventful. Supportive therapy and prevention of sepsis are mainstay of management. Though the use of IVIG has shown conflicting results, our case was successfully managed with IVIG.
接种新冠病毒疫苗后，有多种皮肤不良反应（CARs）的报告。本文介绍一位50多岁的亚洲男性，在接种ChAdOx1 nCov-19疫苗加强针10天后出现坏死性皮肤并累及黏膜。根据病程和形态学表现，怀疑为中毒性表皮坏死松解症（TEN）。患者出现呼吸窘迫并接受插管治疗，按2 g/kg体重给予静脉注射免疫球蛋白（IVIG），之后皮肤病变在第四周愈合，在重症监护病房（ICU）住院50天后患者出院。接种疫苗后严重的CARs较为罕见，在ChAdOx1nCoV-19腺病毒载体疫苗的两种成分中，病毒表位可导致T细胞介导的颗粒溶素和颗粒酶B释放，从而导致表皮剥脱和呼吸道黏膜受累，引起呼吸衰竭。CARs也可能发生在首剂和第二剂接种过程顺利的人群中。支持治疗和预防败血症是主要的治疗方法。虽然IVIG的使用结果存在争议，但我们的病例通过IVIG成功治愈。
