Livedoid skin reaction to 2nd dose of mRNA Covid-19 vaccine

Abstract

Summary Skin often represents a target organ for adverse drug reactions and this also applies to the mRNA vaccines against Sars-CoV-2. Here we present a case of extensive livedoid reaction after 2nd dose of BNT162b-2 vaccine with massive blood skin extravasation and no systemic symptoms apart from anemization. The 30-year-old woman developed progressively enlarging livedoid lesions on limbs and abdomen. Histology showed a near-normal epidermis and a very mild interstitial mixed inflammatory infiltrate with extensive blood extravasation in mid- and deep dermis. Diagnosis was adverse reaction to vaccine with skin capillary hyperpermeability and anaemization with lower than diagnostic features of cutaneous small vessel vasculitis. To date, no cases of a livedoid skin reaction associated to Covid-19 vaccine have been reported, and this case illustrates that massive livedoid reaction can be another kind of skin reaction to mRNA Covid-19 vaccine.

Author’s reply to the Letter to the Editor from Mungunpuntipantip and Wiwanitkit

“…Eventually, they suggested that the livedoid reaction described could be attributable to an asymptomatic COVID-19 infection at the time of vaccination. However, we clearly reported that the patient repeatedly tested negative in the early period before and after the vaccination 1 . Even with the caveat that rapid antigenic tests yield a high specificity but suboptimal sensitivity, repeated testing should be taken as reasonably reliable of the patient’s immunologic status.…”

A Case Report: Long Post-COVID Vaccination Syndrome During the Eleven Months After the Third Moderna Dose

“…Long post-COVID vaccination syndrome can occur at any age, in either sex, and with any vaccine brand [ 4 ]. Long-lasting side effects of SARS-CoV-2 vaccines generally include chills/fever, fatigue, lethargy, dizziness, headache, migraine, ageusia, anosmia, visual disturbances, syncope, palpitations, burning sensation, facial paralysis, parosmia, poor sleep quality, seizure, transient ischemic attack, tremor, thyroiditis, nausea, abdominal pain, diarrhea, vomiting, hypoesthesia, neuralgia, paresis, myalgia, muscle cramps, arthralgias, and various skin reactions [ 4 , 9 , 10 , 11 ]. One of the most common long-term side effects of SARS-CoV-2 vaccines, which has been described in several hundred patients, is vaccine-induced immune thrombotic thrombocytopenia (VITT) [ 12 ].…”

Livedoid skin reaction and mRNA Covid-19 vaccine: correspondence

“…we would like to share ideas on the publication “Livedoid skin reaction to 2nd dose of mRNA Covid-19 vaccine 1 .” Girolami et al observed that no cases of a livedoid skin reaction connected with the Covid-19 vaccine had been documented, and this case demonstrates that a huge livedoid reaction can be another type of skin reaction to the mRNA Covid-19 vaccine 1 . Despite its benefits, the Covid-19 vaccine may be dangerous, which concerns us all.…”