Correspondence urticarial and morbilliform eruptions. Less frequently seen reactions included chilblains, cosmetic filler reactions, herpes zoster or herpes simplex flares, and pityriasis rosea-like reactions. Only two patients had cutaneous vasculitis. Lupus-like skin lesions or lupus deterioration were not reported. 7 Strong agreement exists that all patients with autoimmune rheumatic diseases should be vaccinated against COVID-19. However, SARS-CoV-2 vaccination should be considered as a potential trigger of disease flares, especially in individuals with certain ANA constellations (e.g. anti-Ro/SSA and anti-La/SSB antibodies) predisposing for CLE.

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In a 46-year-old man, a pedunculated rectal polyp measuring 3.0x3.0x2.0 cm was diagnosed histologically as a pyloric gland-type adenoma arising in heterotopic gastric corpus mucosa. The luminal site was covered by glands of the gastric foveolar type, displaying focal marked proliferation interpreted as low-grade intraepithelial neoplasia. A bidirectional gastric differentiation was found: most lower glandular structures showed positivity for the deep gastric mucin core protein Muc 6 and superficial positivity for gastric foveolar epithelium mucin core protein Muc 5AC. Pyloric gland adenoma has so far been described in one larger series only and a few case reports of the stomach, gallbladder, pancreatic duct and within heterotopic gastric corpus mucosa of the duodenal bulb. The present case report is the first case of a pyloric gland-type adenoma within a gastric corpus heterotopia of the rectal mucosa.

Occurrence of left-sided MCCs was significantly more often observed when compared to right-sided tumours. Laterality was not associated with tumour presentation at chronically ultraviolet-exposed sites. Hence, the reason for laterality in MCC remains obscure, but likely goes beyond UV exposure.

Drs Halpern and Gonzalez reported having served on the scientific advisory board of Caliber Imaging and Diagnostics. No other disclosures were reported.

IMPORTANCE Human papillomavirus (HPV)-induced anogenital lesions are very frequent in men who have sex with men (MSM) who are HIV-positive (HIV+). Anogenital warts (AGWs) are considered benign lesions caused by low-risk HPV-types, whereas anogenital dysplasias are potential cancer precursors associated with high-risk HPV-types. Both types of lesions can usually be distinguished clinically. OBJECTIVE To describe a case series of HIV+ MSM with typical AGW that harbored different grades of dysplasia. DESIGN, SETTING, AND PARTICIPANTS For this retrospective virological analysis, we recruited 25 HIV+ MSM with AGWs (n = 38) harboring areas of dysplasia and 22 patients who were HIV-negative (HIV−) with AGWs seen between February 2013 and March 2015 at a tertiary dermatological referral center for anal cancer screening. Dysplasia-containing AGW tissue of HIV+ MSM were compared with randomly selected AGWs of patients who were HIV−. MAIN OUTCOMES AND MEASURES Histopathological analysis, immunohistochemical staining for p16 INK4a and Ki67, HPV-typing, and viral load determination in AGWs of HIV+ compared with patients who were HIV−. RESULTS Overall, 25 HIV+ MSM with AGWs (mean [SD] age, 47.3 [11.1] years) harboring areas of dysplasia and 22 patients who were HIV− (5 women, 17 men; mean [SD] age, 35.5 [12.8] years) with AGWs were included in this study. The 38 dysplasia-containing AGWs of HIV+ MSM harbored low-grade dysplasia in 6 cases (16%), high-grade dysplasia in 31 cases (81%), and areas of invasive anal carcinoma in 1 (3%) case. With the exception of 1 biopsy, all low-grade lesions were p16 INK4a-negative, whereas 25 of 31 (81%) AGWs with high-grade lesions or an anal carcinoma were p16 INK4a-positive. Only low-risk HPV-types were present in 11 samples (29%; 2 low-grade lesions and 9 high-grade lesions), low-risk and high-risk types were found in 19 samples (50%; 1 low-grade lesion and 18 high-grade lesions), and only high-risk HPV-types were present in 8 samples (21%; 3 low-grade lesions, 4 high-grade lesion, and 1 cancer-containing lesion). High low-risk HPV DNA loads were found in low-grade and high-grade lesions, while high high-risk HPV DNA loads were only found in AGWs harboring high-grade lesions. The 22 AGWs of patients who were HIV− showed no signs of dysplasia, and p16 INK4a-staining was always negative. All of these samples carried low-risk HPV types, and in 2 cases high-risk HPV-types were detected additionally. CONCLUSIONS AND RELEVANCE In contrast to immunocompetent patients, AGWs of HIV+ MSM may harbor high-grade dysplasia or even invasive squamous cell carcinoma. A substantial proportion of these lesions may only contain low-risk HPV-types. Anogenital warts in patients who are HIV+ should be evaluated histopathologically to exclude cancer precursors.

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Dear Editor,The recent approval of highly effective prophylactic vaccines against COVID-19 is a monumental step in the global fight against the ongoing SARS-CoV-2 pandemic. Two types of SARS-CoV-2 vaccines are currently used, messenger-RNA (mRNA) vaccines and recombinant adenoviral (AdV) vector vaccines. 1 Both of them encode the production of the SARS-CoV-2 spike protein, which is the primary target for neutralizing antibodies. We report a case of subacute cutaneous lupus erythematosus (SCLE) that transitioned into systemic lupus erythematosus (SLE) following AdV-vaccination with AZD1222.A 62-year-old woman presented with a generalized morbilliform exanthema and new onset of fatigue and musculoskeletal pain (Fig. 1). Six months before the first visit to our department, the patient had experienced erythematosquamous papules and plaques symmetrically located in the sun-exposed areas (chest, upper back, lower arms, and dorsal hands). Laboratory investigations found a normal blood cell count and serum chemistry, but increased titres for antinuclear antibodies (1 : 320; normal <1 : 160) and positivity for anti-Ro/SSA(60) antibodies. All other extractable nuclear antigens were unremarkable. Further