Erythema multiforme, Stevens Johnson syndrome, and toxic epidermal necrolysis reported after vaccination, 1999–2017

Su, John R.; Haber, Penina; Ng, Carmen S.; Marquez, Paige; Dores, Graça M.; Perez‐Vilar, Silvia; Cano, Maria

doi:10.1016/j.vaccine.2019.12.028

Cited by 35 publications

(45 citation statements)

References 43 publications

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“…In December 2020, ModernaTX released the mRNA-1273 (Moderna) vaccine, which is a novel lipid nanoparticle (LNP)-an encapsulated mRNA-based vaccine that codes for the spike (S) protein of SARS-Cov-2 [ 2 , 3 ]. The most common side effects (90%) of the vaccination are headache, muscle pain, redness, swelling, and tenderness at the injection site [ [2] , [3] , [4] ]. There have been dermatological adverse events (AE) cases, such as hypersensitivity reactions to particular ingredients in the vaccine.…”

Section: Introductionmentioning

confidence: 99%

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Bullous drug eruption after second dose of mRNA-1273 (Moderna) COVID-19 vaccine: Case report

Kong

Castillo

Nassar

et al. 2021

Journal of Infection and Public Health

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Background In December 2020, Moderna released the mRNA-1273 vaccine. The most common side effects are headache, muscle pain, redness, swelling, and tenderness at the injection site. In addition, there have been dermatological adverse events, such as hypersensitivity reactions. Although rare, various bullous eruptions have been described following vaccination. Bullous pemphigoid has been reported to occur most often after receipt of influenza and the diphtheria-tetanus-pertussis vaccine. To the best of our knowledge, there have been no reports of bullous drug eruptions resulting from mRNA vaccines. Case summary A 66-years-old obese Guyanese male presented with a bullous rash following receipt of a commercial COVID-19 mRNA vaccine. He received the first dose uneventfully. However, within 24 hours of receiving the second dose, he developed fever, myalgias, and malaise accompanied by a painful blistering rash of his torso, arms, and legs. His fever and myalgias improved after 24 hours, but his painful rash did not, and five days after the initial symptoms, he presented to the hospital. There were many violaceous, poorly demarcated patches on his trunk, arms, and thighs on examination, many of which had large flaccid bullae within, and a few areas on his buttocks, posterior shoulder, and scrotum were eroded. The exam was also significant for lower extremity muscle tenderness, stiffness with preserved strength. A skin biopsy showed epidermal necrosis and sparse perivascular dermatitis concerning Stevens-Johnson syndrome or erythema multiforme. However, in the absence of mucous membrane involvement or targetoid lesions, the diagnosis of an extensive bullous fixed drug eruption was made. Conclusion This case illustrates that the bullae eruption occurred as a result of receiving the Moderna vaccination.

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Section: Introductionmentioning

confidence: 99%

“…EM, SJS, and TEN were rarely reported as a result of vaccination. Most cases were linked to childhood vaccination (combined measles, mumps, and rubella), DtaP, and varicella vaccination [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Bullous drug eruption after second dose of mRNA-1273 (Moderna) COVID-19 vaccine: Case report

Kong

Castillo

Nassar

et al. 2021

Journal of Infection and Public Health

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“…Consequently, the patient evolves with dysphagia and dysphonia, as shown in the case reported. Some vaccines have already been associated with EM (Katoulis et al;Su et al, 2020). According to reports by the Vaccine Adverse Evente Reporting System (VAERS), between 1999 and 2017, 984 cases of EM emerged after vaccination, with smallpox being responsible for most cases (Samim et al).…”

Section: Discussionmentioning

confidence: 99%

Treatment Following Erythema Multiforme in the Oral Mucosa After qHPV Vaccine with Low-Level Laser Therapy: Case Report

Magalhães¹,

Balbino²,

Araújo

et al. 2021

Int. J. Odontostomat.

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Erythema multiforme (EM) is a mucocutaneous condition of uncertain etiology, although the hypersensitivity reaction to a wide variety of agents may be related to the onset of the lesions. In about half of the affected patients it is possible to identify a previous infection. This article aims to report a case of EM in the oralmucosa after qHPV vaccine (Gardasil®), to highlight the diagnostic process and the proposed treatment. Female patient, 16 years old, after 10 days of receiving the first dose of the qHPV vaccine. On physical examination, she presented multiple ulcers and hemorrhagic crusts to the touch, based on the clinical picture and the history of the disease, a diagnostic hypothesis was EM. Low-level laser therapy (LLLT) was chosen as an alternative treatment, since the exercises applied were not successful. The patient was followed up, reported decreased pain and burn and, after one year of treatment, there was no recurrence of the lesions. Laser treatment showed an effective treatment alternative, in addition to the low cost and ease of application.

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“…Varying levels of support suggest involvement of virus, bacteria, and other infections as a trigger for the development of SJS/TEN, though at less frequency levels. The fact that some people vaccinated with meningococcal B vaccine, yellow fever vaccination, influenza vaccination, or virus/bacterial infection had developed SJS or TEN ( Oda et al, 2017 ; Chahal et al, 2018 ; Flora et al, 2018 ; Su et al, 2020 ) indicates that the activated or inactivated microorganisms (vaccine) can cause SJS/TEN. This highlights infection as the new etiology to SJS/TEN.…”

Section: Infection and Sjs/tenmentioning

confidence: 99%

“…( Yang et al, 2019 ; Zhao et al, 2019 ). Some rare cases are caused by less commonly seen drugs like albuterol ( Maggini et al, 2015 ; Shariff et al, 2017 ), taurine-containing energy drink ( Begolli Gerqari et al, 2016 ), radiotherapy for cancers ( Rouyer et al, 2018 ; Esaa et al, 2020 ), fertility treatment ( Hashimoto et al, 2019 ), vaccines ( Oda et al, 2017 ; Chahal et al, 2018 ; Flora et al, 2018 ; Su et al, 2020 ), commercial cannabinoid oil ( Yin et al, 2020 ), herbs ( Bonhomme et al, 2017 ; Lim et al, 2018 ), teriflunomide (treating multiple sclerosis) ( Gerschenfeld et al, 2015 ), methotrimeprazine ( Moubayed et al, 2017 ), diuretic drug metolazone ( Kumar et al, 2016 ), etoricoxib ( Roy et al, 2018 ), Dalbergia cochinchinensis (a tree) ( Yang et al, 2015 ), etc. Anticancer drugs like protein kinase inhibitors ribociclib ( Lopez-Gomez et al, 2019 ), palbociclib ( Karagounis et al, 2018 ), afatinib ( Doesch et al, 2016 ), and vemurafenib ( Arenbergerova et al, 2017 ), immune checkpoint inhibitors (ICIs) (including cytotoxic T lymphocyte associated antigen-4 [CTLA-4: monoclonal antibody ipilimumab ( Dika et al, 2017 )], programmed cell death protein [PD-1: monoclonal antibody nivolumab ( Nayar et al, 2016 ; Salati et al, 2018 ; Dasanu, 2019 ), pembrolizumab ( Lomax et al, 2019 )], programmed cell death ligand 1 [PD-L1: monoclonal antibody atezolizumab ( Chirasuthat and Chayavichitsilp, 2018 )], and CC chemokine receptor 4 targeting antibody mogamulizumab ( Tanba et al, 2016 ) are also reported to cause SJS/TEN.…”

Section: Introductionmentioning

confidence: 99%

Current Pharmacogenetic Perspective on Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Cheng

2021

Front. Pharmacol.

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Adverse drug reactions are a public health issue that draws widespread attention, especially for Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) which have high mortality and lack of efficacious treatment. Though T-cell-mediated HLA-interacted immune response has been extensively studied, our understanding of the mechanism is far from satisfactory. This review summarizes infection (virus, bacterial, and mycoplasma infection), an environmental risk factor, as a trigger for SJS/TEN. The mutations or polymorphisms of drug metabolic enzymes, transporters, receptors, the immune system genes, and T-cell-mediated apoptosis signaling pathways that contribute to SJS/TEN are discussed and summarized. Epigenetics, metabolites, and mobilization of regulatory T cells and tolerogenic myeloid precursors are emerged directions to study SJS/TEN. Ex vivo lymphocyte transformation test has been exploited to aid in identifying the causative drugs. Critical questions on the pathogenesis of SJS/TEN underlying gene polymorphisms and T cell cytotoxicity remain: why some of the patients carrying the risky genes tolerate the drug and do not develop SJS/TEN? What makes the skin and mucous membrane so special to be targeted? Do they relate to skin/mucous expression of transporters? What is the common machinery underlying different HLA-B alleles associated with SJS/TEN and common metabolites?

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Erythema multiforme, Stevens Johnson syndrome, and toxic epidermal necrolysis reported after vaccination, 1999–2017

Cited by 35 publications

References 43 publications

Bullous drug eruption after second dose of mRNA-1273 (Moderna) COVID-19 vaccine: Case report

Bullous drug eruption after second dose of mRNA-1273 (Moderna) COVID-19 vaccine: Case report

Treatment Following Erythema Multiforme in the Oral Mucosa After qHPV Vaccine with Low-Level Laser Therapy: Case Report

Current Pharmacogenetic Perspective on Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

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