Stevens–Johnson syndrome precipitated by Moderna Inc. COVID‐19 vaccine: a case‐based review of literature comparing vaccine and drug‐induced Stevens–Johnson syndrome/toxic epidermal necrolysis

Abstract

The Moderna COVID‐19 vaccination was approved for use in the United States in December of 2020 1 and since that time massive public health efforts have been made to vaccinate patients against the COVID‐19 infection. Adverse reactions from the vaccination are well‐reported and include both local skin reactions, such as pain, swelling, and erythema at the injection site, as well as systemic reactions including fever, malaise, headache, muscle aches, drowsiness, nausea, and vomiting. While severe serious cutaneous adverse reactions, such as Stevens–Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN), remain rare; two cases of SJS/TEN related to COVID‐19 vaccination have been reported. We herein review the two previously reported cases of SJS/TEN and report the first case of SJS precipitated by the Moderna Inc., MRNA 1273 COVID‐19 vaccination in the United States. Although we review potential adverse reactions to vaccination, the benefits of COVID‐19 vaccination outweigh the risks based on current data. Cases should be reported to the Vaccine Adverse Event Reporting System (https://vaers.hhs.gov/) to help public health officials recognize and track these severe but rare adverse events.

Toxic epidermal necrolysis after first dose of Pfizer‐BioNTech (BNT162b2) vaccination with pharmacogenomic testing

“…Five of these patients had underlying diseases, such as hyperlipidemia, diabetes mellitus and breast cancer with a history of medication use. [6][7][8]11,12 All patients had a good prognosis, with a complete time of resolution ranging from 7 days to 35 days. The hospitalization time of drug-induced SJS/TEN in a previous study was 11.8 ± 10.6 days.…”

“…In addition, cases of SJS/TEN associated with the COVID‐19 vaccine have been rarely reported and are summarized in Table 1 . 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 …”

“…Five of these patients had underlying diseases, such as hyperlipidemia, diabetes mellitus and breast cancer with a history of medication use. 6 , 7 , 8 , 11 , 12 Most cases of SJS/TEN occurred following the first dose of COVID‐19 vaccine. The onset of SJS/TEN after vaccination was about 1–2 weeks (1–14 days).…”

“…In addition, cases of SJS/TEN associated with the COVID-19 vaccine have been rarely reported and are summarized in Table 1. [4][5][6][7][8][9][10][11][12] There have been only nine reported cases of SJS/TEN after COVID-19 vaccine. Five of these patients had underlying diseases, such as hyperlipidemia, diabetes mellitus and breast cancer with a history of medication use.…”

“…SJS/TEN is an extremely rare adverse event from basic vaccination. In addition, cases of SJS/TEN associated with the COVID‐19 vaccine have been rarely reported and are summarized in Table 1 4–12 …”