Tozinameran (Pfizer-BioNTech COVID-19 vaccine)-induced AGEP-DRESS syndrome

Tay, Woo Chiao; Lee, Joyce Siong See; Chong, Wei Sheng

doi:10.47102/annals-acadmedsg.2022338

Cited by 6 publications

(7 citation statements)

References 7 publications

(7 reference statements)

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“…Four of the cases [ 15 , 16 , 17 , 18 ] were confirmed with histopathology examination revealing AGEP diagnosis with the presence of discrete and confluent pustules, contrary to the pustular psoriasis Kogoj’s spongiform pustules, which are the accumulations of neutrophils under the stratum corneum. AGEP was combined with DRESS in two of the reported cases.…”

Section: Resultsmentioning

confidence: 87%

“…Cases reported in the review tried to assess the possibility of a pustular eruption connected with COVID-19 vaccination using the Naranjo score as a possible drug reaction [ 30 ]. Also, four of the cases based the diagnosis of AGEP on a histopathology report [ 15 , 16 , 17 , 18 ]. Contrary to AGEP, pustular psoriasis patients are more likely to have a medical history of plaque psoriasis, psoriasis comorbidities, presence of scales in clinical presentation and a histopathology report of spongiosis, macro and micro-pustules and psoriasis histopathology elements such as acanthosis [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

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Pustular Eruption following COVID-19 Vaccination: A Narrative Case-Based Review

Karampinis,

Gravani,

Gidarokosta

et al. 2023

Vaccines

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From the beginning of public vaccinations until the relaxation of COVID-19 measures, many case reports, case series and case–control studies have been published indicating cutaneous side effects of COVID-19 vaccination. Post-vaccination pustular eruption was reported as well, with a challenging differential diagnosis between pustular psoriasis, AGEP (acute generalized exanthematous pustulosis) and neutrophil pustular eruptions. We report a case of 56-year-old woman presented with acute generalized pustular flare up culminated 5 days after the second dose of BNT162b2(Pfizer) vaccination. She was diagnosed with pustular psoriasis flare and due to the regulating role of IL-1 in pustular psoriasis and in the cytokine storm observed in cases of COVID-19 postvaccination inflammation; we decided to treat the patient with an IL-1 antagonist, subcutaneous anakinra (100 mg daily) along with acitretin. One week later, after anakinra withdrawal, she presented a pustular psoriasis flare and a 7-day anakinra re-administration led to a satisfactory improvement in the skin lesions. We also reviewed the medical literature and found 28 case reports with pustular eruption after the COVID-19 vaccination. We compared the patients reported, regarding sex, age, number of doses, post-vaccination period and vaccine brand, and compared those results with our patient. Finally, as indicated by our case and other cases with similarly treated pustular eruptions. targeted therapy to this cytokine imbalance such as anakinra (IL-1) antagonist can improve the clinical course of the patient.

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Section: Resultsmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Pustular Eruption following COVID-19 Vaccination: A Narrative Case-Based Review

Karampinis,

Gravani,

Gidarokosta

et al. 2023

Vaccines

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“…SCARs secondary to COVID‐19 vaccination are increasingly recognised in case reports and case series 19,29‐31 . SCARs include AGEP, drug reaction with eosinophilia and systemic symptoms (DRESS), SJS and toxic epidermal necrolysis (TEN).…”

Section: Cutaneous Adverse Reactionsmentioning

confidence: 99%

“…SCARs secondary to COVID-19 vaccination are increasingly recognised in case reports and case series. 19,[29][30][31] SCARs include AGEP , drug reaction with eosinophilia and systemic symptoms (DRESS), SJS and toxic epidermal necrolysis (TEN). In 12 cases of SJS/TEN following COVID-19 vaccination, the mean age was 56 years with no gender predominance.…”

Section: Severe Cutaneous Adverse Reactionsmentioning

confidence: 99%

Cutaneous reactions secondary to COVID‐19 vaccination

Jmor,

Yip

2023

Prescriber

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“… 4 , 5 More severe SCARs include Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, all of which are even potentially life threatening. 2 It was rarely reported that the AGEP and DRESS syndrome coexisted in the same patient except for few cases owing to several antibiotics 6 , 7 COVID-19 vaccines, 8 , 9 and other causative drugs 10–13 ( Table 1 ). Here, we report a case of AGEP overlapping with DRESS syndrome caused by carbamazepine (CBZ) and levofloxacin treatment after varicella zoster virus infection.…”

Section: Introductionmentioning

confidence: 99%

Severe Cutaneous Adverse Reaction Caused by Carbamazepine and Levofloxacin After Varicella Zoster Virus Infection

Wang¹,

Li²,

Wang³

et al. 2023

IDR

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Severe cutaneous adverse reactions (SCARs) to drugs are associated with morbidity, mortality, healthcare costs, and challenges in drug development. It is important to identify the SCAR type early by using strict diagnostic criteria because they may require different treatments, follow-ups, and short- or long-term prognoses. A 68-year-old woman admitted to our hospital presented with fever and rashes for 10 days. This case exhibited many features that suggested acute generalized exanthematous pustulosis (AGEP). However, the course of treatment and verified clinical features led to a diagnosis of AGEP and drug rash with eosinophilia and systemic symptoms (DRESS) syndrome that was induced by carbamazepine and levofloxacin after a herpes zoster infection. AGEP combined with DRESS syndrome is a complicated and rare drug-induced dermatological eruption that follows a course similar to DRESS syndrome and more recalcitrant than the course seen with typical AGEP. The associated factors for the SCARs in our patient included age, history of allergy, viral infection, and drugs interacting with specific HLA loci. Improving our understanding of these factors can improve the treatment and prevention of SCARs in these patients.

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Tozinameran (Pfizer-BioNTech COVID-19 vaccine)-induced AGEP-DRESS syndrome

Cited by 6 publications

References 7 publications

Pustular Eruption following COVID-19 Vaccination: A Narrative Case-Based Review

Pustular Eruption following COVID-19 Vaccination: A Narrative Case-Based Review

Cutaneous reactions secondary to COVID‐19 vaccination

Severe Cutaneous Adverse Reaction Caused by Carbamazepine and Levofloxacin After Varicella Zoster Virus Infection

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