Bullous drug eruption after second dose of mRNA-1273 (Moderna) COVID-19 vaccine: Case report

Abstract

Background In December 2020, Moderna released the mRNA-1273 vaccine. The most common side effects are headache, muscle pain, redness, swelling, and tenderness at the injection site. In addition, there have been dermatological adverse events, such as hypersensitivity reactions. Although rare, various bullous eruptions have been described following vaccination. Bullous pemphigoid has been reported to occur most often after receipt of influenza and the diphtheria-tetanus-pertussis vaccine. To the best of our knowledge, there have been no reports of bullous drug eruptions resulting from mRNA vaccines. Case summary A 66-years-old obese Guyanese male presented with a bullous rash following receipt of a commercial COVID-19 mRNA vaccine. He received the first dose uneventfully. However, within 24 hours of receiving the second dose, he developed fever, myalgias, and malaise accompanied by a painful blistering rash of his torso, arms, and legs. His fever and myalgias improved after 24 hours, but his painful rash did not, and five days after the initial symptoms, he presented to the hospital. There were many violaceous, poorly demarcated patches on his trunk, arms, and thighs on examination, many of which had large flaccid bullae within, and a few areas on his buttocks, posterior shoulder, and scrotum were eroded. The exam was also significant for lower extremity muscle tenderness, stiffness with preserved strength. A skin biopsy showed epidermal necrosis and sparse perivascular dermatitis concerning Stevens-Johnson syndrome or erythema multiforme. However, in the absence of mucous membrane involvement or targetoid lesions, the diagnosis of an extensive bullous fixed drug eruption was made. Conclusion This case illustrates that the bullae eruption occurred as a result of receiving the Moderna vaccination.

mRNA-1273 COVID-19 vaccination in patients receiving chemotherapy, immunotherapy, or chemoimmunotherapy for solid tumours: a prospective, multicentre, non-inferiority trial

“…Stevens-Johnson syndrome has been associated with immunotherapy, 24 but a causal association with COVID-19 vaccination cannot be excluded with three cases of Stevens-Johnson syndrome after vaccination reported in the published literature so far. 25 , 26 , 27 Although it is conceivable that treatments that boost the immune system, such as vaccination, might contribute to immune-related adverse events in patients treated with immunotherapy, the incidence of such adverse events did not seem to be higher after vaccination and were in line with the expected rate in patients receiving immunotherapy and those receiving chemoimmunotherapy. In another study, no immune-related adverse events were reported in 134 patients treated with immunotherapy who received the BNT162b2 vaccine.…”

Cutaneous Adverse Reactions Associated with SARS-CoV-2 Vaccines

“…The blistering rash appeared after the first dose and worsened after the second dose [53]. Finally, one case of extensive bullous fixed drug eruption was reported the day after the second dose of the Moderna vaccine [54].…”

Can SARS‐CoV‐2 vaccine increase the risk of reactivation of Varicella zoster? A systematic review

“… 4 In the literature, various cutaneous conditions have been observed including anecdotal cases of erythema multiforme with morbilliform rash, delayed‐type hypersensitivity reaction, bullous drug eruption, pernio/chilblains (eg, “COVID toes”), erythromelalgia, and pityriasis‐rosea‐like exanthems, and herpes zoster (HZ). 5 , 6 , 7 , 8 Studies have reported development of herpes zoster due to SARS‐CoV‐2 infection either at the time of disease progression or following recovery from the disease. In the context of COVID‐19 pandemic, studies observed that COVID‐19 is associated lymphopenia, particularly CD3+, CD8+ lymphocytes, and functional impairment of CD4+ T cells, might make a patient more vulnerable to development of herpes zoster.…”