Atypical Presentation of Erythema Nodosum Following Pfizer-BioNTech COVID-19 Vaccine

Abstract

Background: Erythema nodosum (EN) is a common form of panniculitis that could be triggered by numerous conditions including infectious and non-infectious conditions. So far, few cases of EN caused by COVID-19 vaccine had been reported. Case Report: We report a case of atypical presentation of EN mimicking cellulitis in a patient who received the first dose of the Pfizer-BioNTech COVID-19 vaccine. A 38-year-old healthy woman who developed painful swelling on the left leg one week after receiving the first dose of Pfizer-BioNTech COVID-19 vaccine. Skin biopsy was revealed septal panniculitis. Due to the temporal association and the absence of other identifiable causes, Pfizer-BioNTech COVID-19 vaccine-related EN would be the most likely explanation. Conclusion: COVID-19 vaccines could be associated with rare side effects that should be reported for a better understanding of related outcomes of COVID-19 vaccination. This case was reported to keep in mind that EN can have atypical presentation as a rare side effect of COVID-19 vaccines.

A Systematic Review of Histopathologic Surveys on Mucocutaneous Biopsies in Patients Developed COVID-19 Vaccine-Related Dermatologic Manifestations

“…In one study, a biopsy from a cellulite-like lesion, which did not respond to antibiotics, revealed septal infiltration composed of mixed cells, hemorrhage, and edema in the hypodermis with mild septal fibrosis, which was consistent with drug-induced erythema nodusum. 59…”

“…58 In one study, a biopsy from a cellulite-like lesion, which did not respond to antibiotics, revealed septal infiltration composed of mixed cells, hemorrhage, and edema in the hypodermis with mild septal fibrosis, which was consistent with drug-induced erythema nodusum. 59 In a case series of 58 patients, postvaccine reactions had been categorized as vaccine-related papules and plaques (V-REPP), which showed a spectrum of spongiosis and interface changes in microscopy. 60 Perino/Chilblain-like Acral Pattern Histopathologic assessment on post-COVID vaccination chilblain-like lesions presented with superficial and deep dermal inflammatory infiltrates surrounding vessels, sweat glands, and occasionally nerves.…”

Erythema nodosum following COVID‐19 vaccination: A case report and literature review

“…Of the 405 skin reactions reported following COVID-19 vaccination (within 21 days after vaccination) via a questionnaire survey in Spain, the COVID arm accounted for 32.1%; however, EN was not reported as a COVID-19 vaccination-induced skin reaction. 7 Table 1 presents 18 case reports regarding EN following COVID-19 vaccination, [2][3][4][5][6][8][9][10][11][12][13][14][15][16][17][18] which mostly develops on the extremities (especially the lower limbs) of adult women and improves within 1 month. These features are similar to those of common (irrelevant to COVID-19 vaccination) EN.…”