Pyoderma gangrenosum following vaccination against coronavirus disease‐2019: a case report

Toyama, Yuichi; Maekawa, Takeo; Komine, Mayumi; Ohtsuki, Mamitaro

doi:10.1111/ijd.16255

Cited by 6 publications

(3 citation statements)

References 4 publications

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“…There have been several studies reporting skin adverse events after COVID-19 vaccination, including PG [30][31][32][33][34]. This is not the case in our patient since her last COVID-19 vaccination was one year prior to her disease relapse.…”

Section: Discussionmentioning

confidence: 54%

Exacerbation of Behcet’s Disease and Pyoderma Gangrenosum Following COVID-19 Infection: A Case Report

Álvarez Pérez,

Vila

2023

Cureus

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Behcet’s disease (BD) and pyoderma gangrenosum (PG) are rare autoimmune inflammatory diseases that have been reported to relapse following COVID-19 infection. BD is a multisystemic syndrome that may involve multiple body organs. PG is a skin disease that can be a part of the skin involvement of BD. We report a 33-year-old woman with BD and PG who developed headaches, arthralgias, and rapidly progressive painful skin ulcers after COVID-19. She had not complained about BD or PG symptoms for two years prior to admission. Treatment at admission comprised infliximab 560 mg every eight weeks, azathioprine 50 mg daily, and low-dose aspirin. Due to the suspicion of neuro BD and the rapid appearance and progression of the ulcers, she was treated with intravenous (IV) methylprednisolone 1000 mg daily three times followed by prednisone at 1 mg/kg/day. Azathioprine was increased to 100 mg bid. Local ulcer care was provided. She was discharged home on the eighth hospital day. The arthralgias were completely gone, and the headaches and skin ulcers had improved. Six months after discharge, she was off prednisone and continued infliximab and azathioprine. She had no headaches or joint pains, and the ulcers had completely healed. One year after admission, BD and PG signs and symptoms had completely disappeared. This case highlights the importance of recognizing that autoimmune diseases may exacerbate COVID-19. Timely management is crucial to prevent complications and morbidity. To our knowledge, this is a rare case report describing BD and PG exacerbation following COVID-19.

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Section: Discussionmentioning

confidence: 54%

Exacerbation of Behcet’s Disease and Pyoderma Gangrenosum Following COVID-19 Infection: A Case Report

Álvarez Pérez,

Vila

2023

Cureus

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“…A total of 164 non‐injection‐site reactions in 161 patients have been reported in previous case reports and series 7–88 . Patients with systemic lupus erythematosus (SLE) and lupus erythematosus profundus (LEP) showed exacerbation of lupus eruptions after 2 weeks, and other AEs developed several months later.…”

Section: Resultsmentioning

confidence: 99%

Cutaneous adverse events following COVID‐19 vaccination: A case series of 30 Japanese patients and a review of 93 Japanese studies

Baba,

Yamada,

Kanekura

2024

The Journal of Dermatology

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In Japan, cutaneous adverse events (AEs) following the coronavirus disease 2019 (COVID‐19) vaccination have been frequently described; however, a larger case series and literature review are lacking. There is an urgent need for an extensive investigation of new cases and previous reports to provide a thorough body of information about post‐COVID‐19 immunization cutaneous AEs. We aimed to analyze patients with cutaneous AEs after COVID‐19 vaccination in our hospital and review previous studies of cutaneous AEs. We analyzed post‐COVID‐19 vaccination cutaneous AEs in our department, the Japanese Registry, and previous literature. We enrolled 30 patients with cutaneous post‐vaccination AEs in our department over 2 years (April 1, 2021, to March 31, 2023). We also confirmed cases registered in the Ministry of Health, Labor, and Welfare COVID‐19 vaccine side effect reporting system (February 17, 2021–March 12, 2023). A total of 587 records were retrieved and 93 articles were included for data extraction. A total of 28 non‐injection‐site cutaneous AEs and two injection‐site AEs were identified. Six (20.0%) patients developed new‐onset erythematous eruptions, and five (16.7%) patients developed urticaria. Pruritic eruption, eczema, shingles, and sweating symptoms have also been reported. In previous studies on non‐injection‐site cutaneous AEs, individuals who received the BNT162b2 vaccine were older than those who received mRNA‐1273 (P < 0.01). Cutaneous AEs were mostly nonsignificant and self‐limiting reactions; however, rare, severe, or life‐threatening AEs were also reported. Physicians should be aware of the various possible cutaneous AEs associated with the COVID‐19 vaccination.

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“…Several studies over the past 2 years have reported skin side-effects after COVID-19 vaccination, including PG. 17 – 21 To the best of our knowledge, a PG ulcer triggered by COVID-19 vaccination in a patient with UC has not been reported.…”

Section: Discussionmentioning

confidence: 99%

Pyoderma Gangrenosum Triggered by COVID-19 Vaccination in a Patient with Ulcerative Colitis: A Case Report

Kim

Shim

Jeong

et al. 2022

The International Journal of Lower Extremity Wounds

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Pyoderma gangrenosum (PG) is a rare inflammatory skin disease that is difficult to diagnose. PG may be an extra-intestinal manifestation of ulcerative colitis (UC). In recent times, coronavirus disease (COVID-19) vaccines have caused various adverse cutaneous reactions. However, to the best our knowledge, combinations thereof have not been reported. We encountered a case of PG triggered by COVID-19 vaccination in a patient with UC. A 40-year-old woman developed severe pain and an abscess in the dorsum of the left foot after receiving the first dose of the messenger RNA (mRNA)-based Pfizer/BioNTech BNT162b2 COVID-19 vaccine. Severe painful ulcers with purulent necrosis and gaseous gangrene progressed rapidly along the extensor tendons and muscles to the toes and ankle. Although surgical debridement can worsen PG by triggering pathergy, we nonetheless performed wide debridement including partial extensor tenotomy with abscess drainage to prevent progression to pyogenic ankle arthritis and to rescue the toes. Antibiotics, corticosteroids, and anticoagulants were prescribed during surgical wound management via negative pressure therapy. After the lesion improved, the skin and soft tissue defect were covered using a superficial circumflex iliac artery perforator free flap and a split-thickness skin graft. The patient was satisfied with the foot salvage, and could walk unaided (without a brace or cane) from 8 weeks after the final surgery. PG may be rare even in UC patients, but mRNA-based COVID-19 vaccines may find an immunosuppressive niche. A high level of caution and suspicion of skin manifestations after vaccination is essential.

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Pyoderma gangrenosum following vaccination against coronavirus disease‐2019: a case report

Cited by 6 publications

References 4 publications

Exacerbation of Behcet’s Disease and Pyoderma Gangrenosum Following COVID-19 Infection: A Case Report

Exacerbation of Behcet’s Disease and Pyoderma Gangrenosum Following COVID-19 Infection: A Case Report

Cutaneous adverse events following COVID‐19 vaccination: A case series of 30 Japanese patients and a review of 93 Japanese studies

Pyoderma Gangrenosum Triggered by COVID-19 Vaccination in a Patient with Ulcerative Colitis: A Case Report

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