Development of eruptive pseudoangiomatosis following COVID‐19 immunization – Apropos of 5 cases

Abstract

progressive improvement of pruritus was noted. The eruption regressed spontaneously after 3 weeks.Among the cutaneous manifestations of COVID-19 infection, maculopapular rashes account for almost 50% of cases. 3 Rarely, these may resemble or are identical to PR. Ehsanixi et al. recently reported an otherwise healthy young man with a typical PR eruption concurrent with COVID-19 pneumonia. 4 Isolated reports of PR developing in asymptomatic patients have also been described. 5 Drug-induced PR-like eruptions (PR-LE), in contrast to typical PR, often lack the herald patch, tend to be itchy, more diffuse and confluent, and the mucous membranes can be involved. Patients do not experience prodromal symptoms, and blood or/ and dermal eosinophilia may be found, and there are no signs of HHV-6/7 systemic reactivation. 2 Pityriasis rosea and PR-like eruptions have rarely been observed to develop after vaccinations. Cases of PR/PR-LE after vaccination for smallpox, tuberculosis, influenza, influenza A (H1N1), diphtheria, tetanus, diphtheria-pertussis-tetanus (DTP), papillomaviruses, yellow fever, hepatitis B and pneumoccus have been reported in the literature. 2,6 In such instances, the average time lapse between vaccination and eruption onset ranged from 5 to 17 days, and the exanthema lasted from 2 to 6 weeks. Differentiation between 'true' PR and PR-LE was difficult and virological investigations for HHV-6/7 reactivation were performed only in a minority of cases. In cases of vaccineinduced PR, a high cytokine response to the vaccine leading to an immune deregulation and reactivation of latent viral infections, such as HHV6 and HHV7, has been hypothesized. 7 As far as we are concerned, no previous reports of PR developing after COVID-19 vaccination have been reported.In our cases, prodromal symptoms were absent; the presence of herald patch was present in one case; exacerbation after the second dose administration was observed in one patient; and histopathological findings were consistent with typical PR. Therefore, we suggest that COVID-19 vaccination should be included in the list of potential triggers of PR. Development of PR/PR-LE after COVID-19 vaccination seems to be a rare event. Only further additional reports will demonstrate the real significance and prevalence of this potential side effect of COVID-19 vaccination.

Eruptive Angiomatosis Triggered by COVID-19 Vaccination

“…Vascular lesions including eruptive cherry angiomas have been reported secondary to COVID-19, which could be mediated by angiotensin-converting enzyme 2 (ACE2) receptors; subsequent endothelial damage has also been reported [5,6]. Mohta et al have reported 12 cases of eruptive pseudoangiomatosis, a similar vascular lesion that commonly occurs in the pediatric age group and is associated with ChAdOx1 nCoV-19 coronavirus vaccine (recombinant) in India [7]. The possible vascular injury [8,9] or immune dysregulation [10] caused by the COVID-19 vaccination could play a role in the development of these eruptive vascular lesions.…”

Clinical, histopathological, and dermatoscopic characterization of eruptive pseudoangioma developing after COVID‐19 vaccination—A case‐series

“… 2 , 3 Till date, only 6 cases of EP secondary to COVID‐19 vaccine have been reported in literature. 4 , 5 The proposed hypothesis is upregulation of cellular and humoral immunity against the spike protein in the viral vaccine stimulating a paraviral response. 5 In our experience, the estimated incidence of EP following COVID‐19 vaccination is as low as 0.03%.…”

“…4,5 The proposed hypothesis is upregulation of cellular and humoral immunity against the spike protein in the viral vaccine stimulating a paraviral response. 5 In our experience, the estimated incidence of EP following COVID-19 vaccination is as low as 0.03%. According to our results, EP is predominantly a disease of younger age groups.…”

Eruptive pyogenic granulomas following coronavirus disease 2019

“…Anti-SARS-CoV-2 vaccine-related cutaneous vascular eruptions have also been recorded, with six cases of EP (Covishield, 5; ModernaCambridge, MA, USA, 1) 7,8 and one of eruptive cherry angiomas 9 described to this date (Pfizer; Table 1).…”