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Vaccines are today considered one of the most effective means against the Sars-CoV-2 pandemic. The BNT162b2 vaccine by Pfizer/BioNTech has been massively administered throughout the globe; since its approval, a wide spectrum of cutaneous reactions has been reported. Here we report the case of a 52-year-old Caucasian male who presented with an acute febrile eruption that arose 72 h after the first dose of the BNT162b2 vaccine. The clinicopathological findings were consistent with Sweet’s syndrome. The short latency time suggested a possible role of the vaccine in triggering Sweet’s syndrome in this case.

Bullous pemphigoid (BP) represents the most common autoimmune bullous disease and is characterized by IgG autoantibodies targeting collagen XVII (BP180). BP has reportedly been occurred in association with other inflammatory skin diseases. Here, we describe the unusual occurrence of BP in a female patient with a concomitant history of generalized morphea (localized scleroderma, LoS) and cutaneous and genital lichen sclerosus (LiS). The occurrence of BP was associated with elevated serum levels of anti-BP180 IgG autoantibodies, which decreased upon clinical remission. Autoimmune bullous diseases and sclerosing dermatitis are immunologically distinct entities, whose association has been rarely described. In this study, we provide a literature review on cases of BP developed in patients with either LoS or LiS. Further, we discussed immunological mechanisms which may have favored the emergence of BP in our patient.

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Immunoblotting (IB) using lysate of A431 cell (ATCC® CRL-1555™) (cell applications, San Diego, CA, USA) performed with a commercial antibody directed to the C-terminal portion of β4 integrin (B7, Santa Cruz biotechnology, Dallas, TX, USA). A431 cells were transfected either with a negative control siRNA (A431) or with a β4 integrin-specific siRNA (β4 integrin siRNA sc-35678, Santa Cruz biotechnology) (A431 ITGB4-). Immunoblotting was then performed with the indicated antibodies. β-Actin IB was performed to verify the equality in protein loading. Molecular weight markers are indicated on the left. (b) Quantification and graphical reproduction of the IB signal relative to the higher and lower molecular weight bands of β4 integrin before and after silencing of β4 integrin. Data were normalized for β-Actin content. (c) Like the commercial antibody, sera from five Japanese patients with ocular MMP demonstrated reactivity to the 250 kDa band corresponding to β4 integrin in IB of A431 cell lysates. Some sera also demonstrated weakly reactivity to the 205 kDa band. (d) Reactivity to β4 integrin of MMP sera using IB of A431 cell lysates. Representative images from two patients positive for anti-β4 integrin antibodies as well as one patient and a healthy control negative for anti-β4 integrin antibodies were shown. Patients were considered positive for anti-β4 integrin autoantibodies when the major and/or the lower molecular weight bands detected with sera (green) or with the commercial antibody (red) were superposed (yellow). Specificity of the obtained bands is witnessed by their reduction upon β4 integrin silencing. Serum of patient 1 reacted with the 250 kDa protein band only, while the serum from patient 2 demonstrated the presence of both the 250 and 205 kDa bands. Like the healthy control, patient 3 demonstrated no antibodies to β4 integrin. ITGB4, β4 Integrin; mAb, Monoclonal antibody.