Stevens-Johnson syndrome related with Comirnaty® coronavirus disease 2019 vaccine

Abstract

Stevens-Johnson syndrome is a rare severe delayed-type hypersensitivity reaction. Even though not initially described as a side-effect of the Comirnaty® coronavirus disease 2019 (COVID-19) Vaccine, the worldwide public COVID-19 vaccination programs are uncovering this serious adverse event. We present the case of a 44-year-old woman, vaccinated with the 1st dose in July 2021, and the 2nd dose 4 weeks later. Five days after the 2nd dose, a 10 cm, circular, painful, violet/red lesion appeared on the injection site. From then on, multiple, generalized purpuric painful lesions appeared, associated with ulcers on the lips, oral cavity, nasal cavity, vulva, and vagina, oedema of the hands and feet, conjunctival erythema, blurred vision, and malaise. The patient was being treated with lamotrigine and sodium valproate (for 2 years, without interruptions or dose change) which were stopped, and the patient started treatment with systemic corticosteroids. Lymphocyte transformation test were performed and were positive for PEG2000 1 μg/mL (stimulation index [SI], 30.9), and the undiluted Comirnaty® vaccine (SI, 32.2). These tests were negative on several vaccinated controls. We can definitively show that sensitization to the vaccine and PEG2000 can occur. A more extensive evaluation and reporting is needed to know the true incidence of this life-threatening condition and possible risk factors; as not only further booster shots of this vaccine will be administered, but also new vaccines with the mRNA technology are likely to be more prevalent in the future.

Cutaneous Adverse Events After COVID-19 Vaccination

“…32,33 There have been only 11 case reports of SJS or TEN, which have occurred after several COVID-19 vaccines, for example, PZ, Mo, AZ, SP, and Janssen, started 1 to 14 days post vaccine and lasted 7 to 35 days. 7,34 There were no deaths, and all patients had a good outcome after treatment with prednisolone, dexamethasone, etanercept, and IVIG. In our study, one participant experienced SJS 4 days after the SP vaccine.…”

Acute vulvar ulcer as a possible adverse event of gene‐basedCOVID‐19 vaccines: A review of 14 cases

“…The interval from vaccine receipt to ulcer onset was 2.4 ± 1.2 (0–4) days ( n = 14); This skewed distribution, with a sharp peak at 2 days after vaccine receipt, do not support coincidental association between vaccination and ulceration (Figure 2). The interval from the vaccine receipt to ulcer resolution was 16.9 ± 7.4 7–28 ( n = 10). In all 13 cases with a described prognosis, the ulcer resolved.…”

“…Flow chart for case selection. One vulvar ulcer case with a diagnosis of Steven‐Johnson syndrome 26 and one SARS‐COV2 PCR‐positive vulvar ulcer case with a history of COVID‐19 vaccination 4 months before ulcer onset were excluded 27 . There were 4 articles that were not the case reports: a review on Behçet's disease that referred to oro‐genital ulcers, 28 an original article on a potential COVID drug, 29 and 2 editorials on vulvar ulcers following COVID‐19 vaccination 18,30 …”

The pathophysiology and clinical phenotypes of COVID-19 mRNA vaccine-related cutaneous adverse reactions: A narrative review

“…Zou and Daveluy [103] collected 12 cases with TEN/SJS after COVID-19 vaccinations [83,102,[104][105][106][107][108][109][110][111][112][113] along with 22 cases with TEN/SJS after COVID-19 infection, which had been reported until August 2022. Seven additional case reports (7 patients) of vaccine-related SJS/TEN were found at the time of manuscript writing in Oct 2023 [114][115][116][117][118][119][120] . Vaccines used in 19 patients were Moderna-1273 (n = 6), BNT162b2 (n = 4), ChAdOx1 nCoV-19 (n = 4) and BBIBB-CorV (n = 5).…”