Background The safety of a third dose of SARS-CoV-2 mRNA vaccination in patients with inflammatory bowel disease is unknown. Methods We compared symptoms following a third SARS-CoV-2 mRNA vaccine dose with symptoms after the second dose in IBD. Results The study group included 594 patients (70% female, 58% BNT162b2). Overall, 41% reported symptoms after a third dose. Symptom frequency and severity were lower after the third dose relative to the second dose for every organ system, except for gastrointestinal symptoms which were marginally worse. Conclusion The frequency and severity of symptoms after a third mRNA vaccine dose are generally similar or milder than after a second dose for most organ systems.

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Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a rare drug reaction that commonly presents with rash, fever, lymphadenopathy, eosinophilia, and multiorgan involvement. We present a case of this syndrome in a 31-year-old male who presented with a diffuse erythematous morbilliform rash with high fever and elevated liver enzymes. Upon history taking, the patient reported acute onset of multiple seizures that required intubation and ICU admission six weeks prior, which started 24 hours after receiving the Johnson and Johnson Janssen coronavirus disease 2019 (COVID-19) vaccine. During that hospitalization, he was given antiseizure medications Keppra (levetiracetam) and Dilantin (phenytoin), which he was eventually discharged home with. During our encounter with the patient, Dermatology was consulted and recommended punch skin biopsy, which revealed spongiotic dermatitis with subcorneal pustules along with superficial perivascular and mixed lymphocytic and neutrophilic infiltrate with dermal edema and rare eosinophils. Given these findings in conjunction with the patient's fever, elevated liver function, and cervical lymphadenopathy, the rash was consistent with DRESS syndrome or a pustular drug eruption likely secondary to phenytoin or levetiracetam. This case was eventually resolved with treatment with oral and topical corticosteroids and close outpatient follow-up with Dermatology. Prompt diagnosis and treatment of DRESS syndrome are therefore critical as the mortality rate can be as high as 10% in the setting of liver failure.

Both breasts are relatively symmetric structures in both size and tissue pattern on mammography. Finding asymmetry is relatively common and can be due to normal physiological and many pathological changes, in most cases of benign nature. However it may indicate underlying malignancy. Objective: the aim of this study was to evaluate the role of digital mammography in asymmetric breast findings in correlation with ultrasound. Patients and methods: Thirty women underwent breast ultrasonography after finding of asymmetry at mammography. Mammograms and sonograms were evaluated for site and type of asymmetry, associated calcifications, architectural distortion and change from previous examination when available. Biopsy and histopathology was done for cases suspicious for malignancy. Results: 66.7% of cases had focal asymmetry and 33.3% had global asymmetry. Asymmetry mostly (76.7% of the cases) represented normal variation of breast tissue distribution, post-operative changes or other benign conditions such as fibrocystic changes, ductectasia, and inflammation. On the other hand, 23.3% of cases are proved to have malignancy. Conclusion: Asymmetric breast findings are mostly due to benign etiologies, however, the possibility of underlying malignant cause is also present in lower percentage especially when accompanied by other clinical and radiological suspicious findings.