Generalized Papulovesicular Eruption as a Side Effect of the Pfizer-BioNTech COVID-19 Vaccine

Abstract

COVID-19 is inflicted by SARS-CoV-2 and resulted in a global health crisis that necessitated the urgency of vaccine development to prevent its spreading among the public. Pfizer-BioNTech COVID-19 is one of the emergency use authorized (EUA) vaccines. This vaccine is efficacious against the SARS-CoV-2 virus; nonetheless, recipients have frequently reported side effects. Recipients of this vaccine experienced miscellaneous side effects like fatigue and headache. However, cutaneous eruptions of varying degrees of severity and involvements have been manifesting post-vaccination. Dermatological eruptions following vaccination against COVID-19 disease are poorly recognized. Dermatological manifestations triggered postvaccination differ in the clinical context and patient's demographic features. The only constant factor is various clinical and histopathological relations to establish the diagnosis of cutaneous eruption postvaccination.Herein, we report a case of an 18-year-old male with T-cell acute lymphocytic lymphoma (ALL) in remission since August 2018 and other comorbidities. After the administration of the first dose of the Pfizer-BioNTech COVID-19 vaccine, the patient developed pruritic eczematous eruption presenting as grouped erythematous-violaceous papulovesicular lesions with fine scales over his upper and lower extremities. These eruptions started two days after the administration of the vaccine. This eruption became generalized 21 days after receiving the second dose of the Pfizer-BioNTech COVID-19 vaccine. Clinical suspicion of the drug-induced vesicular eruption was suspected; thus, a biopsy was obtained and showed erosions and mixed inflammatory cell infiltrate. From a clinical and histopathological correlation, vesicular eruption following vaccination with Pfizer-BioNTech COVID-19 was confirmed. Nevertheless, other diagnoses cannot be ruled out, but from the clinical-histopathological association, the vaccine-inflicted eruption is the likely culprit. Reports are crucial to understanding the nature of such dermatological manifestation after emerging diseases and counteractions like vaccinations. The dermatological manifestations are vaguely recognized; thus, by reporting on the cases similar to the case in this report, more data will be available to understand the nature and underlying cause of such eruptions.

Generalized painful papulovesicular eruption following the COVID‐19 BNT162b2 mRNA vaccine

“…To date, only a few cases of diffusely distributed papulovesicular eruptions developing post-COVID-19 vaccination that are comparable with our case have been reported (Table 1). 8,9 Our patient experienced more severe symptoms than the others and the time interval between vaccination and the onset of cutaneous symptoms was longer (11 days; other cases 2-7 days). Skin biopsy was not performed for the other cases.…”

A Case of Acral Papulovesicular Rash Associated With COVID-19

“…In the literature, a case of papulovesicular eruption with onset in the acral region was presented following the first dose of the Pfizer-BioNTech COVID-19 vaccine in an 18-year-old male patient. This eruption progressed to a generalized papulovesicular eruption after the second dosage of the vaccine [ 10 ]. Nevertheless, in our case, we observed a self-limiting papulovesicular exanthem on the acral region, which did not become generalized.…”

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

“…[63][64][65] In studies, perivascular and interstitial lymphocytic and histiocytic infiltration and RBC extravasation were also reported. [63][64][65][66][67] In one study, immunohistochemistry assessment on a sample for varicella-zoster virus was positive. 66…”