An unusual presentation of pemphigus foliaceus following COVID‐19 vaccination

Lua, Angelyn Chen Yin; Ong, Felicia Li Ling; Choo, Karen Jui Lin; Yeo, Yoomi; Oh, Choon Chiat

doi:10.1111/ajd.13755

Cited by 17 publications

(20 citation statements)

References 10 publications

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“…Based on the available data, the chief concern for patients with immune-mediated inflammatory diseases, including pemphigus, appears to be the efficacy of the immune responses these patients will be able to generate after receiving Rituximab. Patients treated with Rituximab may require an extra vaccine booster to enable reasonable antibody responses following mRNA-based SARS-CoV-2 vaccination [ 37 ]. However, as no cutoff titer that is most strongly associated with sufficient protection has been defined, the effect of reduced antibody levels on protection remains unclear.…”

Section: Immune Responses To Covid-19 Vaccines In Rituximab Treatmentmentioning

confidence: 99%

Pemphigus during the COVID-19 Epidemic: Infection Risk, Vaccine Responses and Management Strategies

Huang

Liang

Zhang

et al. 2022

JCM

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Pemphigus is a rare autoimmune blistering disease, involving potentially life-threatening conditions often requiring immunosuppression. Currently, the COVID-19 pandemic caused by severe acute respiratory disease coronavirus 2 (SARS-CoV-2) infection has become a global public emergency. Vaccines are the most effective defense against COVID-19 infection. However, in clinic, there are cases of new onset or flare of pemphigus following COVID-19 vaccination, where vaccines have manifested significantly desirable risk-benefit profiles for patients. Although Rituximab, as first-line therapy, may impair humoral immunity, pemphigus may not predispose to develop COVID-19 infection compared to a healthy population. Conversely, delay or interruption of immunosuppressants probably results in unfavorable clinical outcomes for disease progression. Overall, clinicians should encourage their patients to undergo the vaccination after a comprehensive assessment. The definite association between COVID-19 vaccination and pemphigus remains to be further elucidated. Herein, we provide an overview of the published studies to date on COVID-19 and pemphigus as well as the exploration of their complicated interplay. In addition, we discuss the management strategies for pemphigus patients in this special period, in an effort to more effectively establish a standard treatment paradigm for this particular patient group.

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Section: Immune Responses To Covid-19 Vaccines In Rituximab Treatmentmentioning

confidence: 99%

Pemphigus during the COVID-19 Epidemic: Infection Risk, Vaccine Responses and Management Strategies

Huang

Liang

Zhang

et al. 2022

JCM

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“…A total of 195 articles was retrieved and after the screening, 20 articles were finally included for the review. A total of 35 AIBDs cases (including our case) were found, as shown in Table 1 [7] , [8] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] . The sub-epithelial diseases were the most frequent, accounting for 28 cases (80.0%), specifically 26 cases of BP (74.3%) and 2 case of LABD (5.7%).…”

Section: Resultsmentioning

confidence: 99%

Autoimmune mucocutaneous blistering diseases after SARS-Cov-2 vaccination: A Case report of Pemphigus Vulgaris and a literature review

Calabria

Canfora

Mascolo

et al. 2022

Pathology - Research and Practice

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“…In the current work one patient relapsed following COVID‐19 vaccination. Few reports showed either onset or flare of autoimmune bullous disease patients following vaccination for COVID‐19 13–15 . The occurrence of flare following vaccination could be a coincidence however it is possible that the vaccine may play a role in triggering or initiation of autoimmune bullous diseases.…”

Section: Discussionmentioning

confidence: 99%

“…Few reports showed either onset or flare of autoimmune bullous disease patients following vaccination for COVID-19. [13][14][15] The occurrence of flare following vaccination could be a coincidence however it is possible that the vaccine may play a role in triggering or initiation of autoimmune bullous diseases. More studies are needed to better understand the COVID-19 vaccine side effects.…”

Section: T a B L E 1 Demographic Data Of The Pemphigus Vulgaris Patientsmentioning

confidence: 99%

Pemphigus vulgaris relapse during the coronavirus disease pandemic

Saleh

2022

Dermatologic Therapy

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Pemphigus vulgaris (PV) is the most common type of pemphigus group of autoimmune skin diseases. The treatment of PV relapse is challenging especially during the coronavirus disease (COVID-19) pandemic. In this prospective study, we aimed to evaluate the treatment of patients with relapsing PV during the pandemic.Twelve patients with PV who experienced relapse from March 2020 to January 2022 were included. The patients were asked whether they experienced COVID-19 symptoms and the pemphigus disease area index (PDAI) was measured. PCR for COVID-19, chest computed tomography, routine investigations, and electrocardiography were performed for the admitted patients. The mean PDAI of the patients during relapse was 23.6 ± 14.8 (range 5-60). Seven patients received azathioprine; one patient received mycophenolate mofetil; and six patients received 1000 mg of rituximab (RTX) twice at an interval of 14 days. None of the 12 patients had COVID-19-suggestive symptoms. Only 1 patient relapsed after receiving the COVID-19 vaccine. The six admitted patients who received RTX were negative for COVID-19 based on the PCR testing results. Out of the 12 patients, eight achieved complete remission, while four achieved partial remission. No major adverse effects were observed. In conclusion, the treatments with systemic steroids, immunosuppressive drugs, and rituximab were well tolerated by the patients with relapsing PV, provided that there was no contact with individuals with COVID-19. These treatments can then be provided to patients with PV during the pandemic with careful follow-up.

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An unusual presentation of pemphigus foliaceus following COVID‐19 vaccination

Cited by 17 publications

References 10 publications

Pemphigus during the COVID-19 Epidemic: Infection Risk, Vaccine Responses and Management Strategies

Pemphigus during the COVID-19 Epidemic: Infection Risk, Vaccine Responses and Management Strategies

Autoimmune mucocutaneous blistering diseases after SARS-Cov-2 vaccination: A Case report of Pemphigus Vulgaris and a literature review

Pemphigus vulgaris relapse during the coronavirus disease pandemic

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