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• W3217239274 abstract "A 75-year-old man was referred to us because of a 1-month history of pruritic skin rash. Physical examination revealed generalized scaly erythematous macules and plaques with scratch marks over almost his entire body; he had developed erythroderma (Figure 1a,b). Thick scaly plaques with fissures were also observed on the chest (Figure 1a). The skin lesions appeared on the patient's extremities 3 days after receiving the second dose of tozinameran (BNT162b2, Pfizer-BioNTech), and had spread to the entire body. He had no relevant past medical history or comorbidities. There was no history of antecedent infections or recent medications. Laboratory tests showed elevated serum levels of immunoglobulin E (IgE, 544 U/mL [normal, <216 U/mL]) and thymus and activation-regulated chemokine (TARC, 4717 pg/mL [normal, <450 pg/mL]). White blood cell count and eosinophil count were within normal levels. A biopsied specimen was obtained from a scaly erythematous patch on the dorsum of the patient's hand (Figure 1c). Histopathological findings showed acanthosis and perivascular inflammatory cell infiltration in the upper dermis at low magnification (Figure 1d). At high magnification, spongiosis with lymphocytic exocytosis and vacuolar degeneration of the basal stratum were also observed (Figure 1e,f). Therefore, a diagnosis of eczematous erythroderma was made. He was treated with topical betamethasone butyrate propionate ointment and oral antihistamines, and the lesions promptly healed without relapse. Many cases of coronavirus disease 2019 (COVID-19)-vaccine-related cutaneous reactions have been reported and the most common morphologies were delayed large local reactions, local injection site reactions, urticaria, and morbilliform eruptions.1 Cutaneous reactions after COVID-19 vaccination seem to be heterogeneous, and most are mild-to-moderate and self-limiting.1, 2 However, some are severe/very-severe and require treatment. In our case, the cutaneous reactions were prolonged and severe, although using topical corticosteroids led to rapid improvement. To our knowledge, there have never been any reports showing erythroderma following COVID-19 vaccination. There is a possibility that the patient's cutaneous symptoms may be fully due to COVID-19 vaccination, while there is another possibility that the first symptoms that were caused by COVID-19 vaccination may have been worsened and prolonged by repetitive scratching. Magro et al. described the histopathological findings of COVID-19-vaccine-induced changes in the skin.3 They reported that the most common pattern was eczematous dermatitis and/or concomitant cytotoxic interface dermatitis, which was also observed in our case. Delayed cutaneous adverse reactions may occur either as a primary manifestation or as a flare of a pre-existing inflammatory dermatosis and can be divided according to the cytokine profile, based on the preponderance of specific T-cell subsets (i.e., Th1, Th2, Th17/22, Tregs).4 Our patient did not have a pre-existing inflammatory dermatosis. Serum levels of IgE and TARC were elevated, suggesting an underlying Th2 dominant immune response. Numerous components of vaccines may act as haptens, which lead to a predominantly Th2-polarized inflammatory reaction with increased levels of IL-4 and IL-13.4 As the skin lesions appeared after receiving the second dose of vaccine, it is considered that our patient had a prior sensitization to vaccine components. The authors declare no conflict of interest." @default.
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• W3217239274 date "2021-11-25" @default.
• W3217239274 modified "2023-09-25" @default.
• W3217239274 title "A case of erythroderma with elevated serum immunoglobulin E and thymus and activation‐regulated chemokine levels following coronavirus disease 2019 vaccination" @default.
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• W3217239274 doi "https://doi.org/10.1111/1346-8138.16257" @default.
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