Transition of cutaneous into systemic lupus erythematosus following adenoviral vector‐based SARS‐CoV‐2 vaccination

Abstract

Dear Editor,The recent approval of highly effective prophylactic vaccines against COVID-19 is a monumental step in the global fight against the ongoing SARS-CoV-2 pandemic. Two types of SARS-CoV-2 vaccines are currently used, messenger-RNA (mRNA) vaccines and recombinant adenoviral (AdV) vector vaccines. 1 Both of them encode the production of the SARS-CoV-2 spike protein, which is the primary target for neutralizing antibodies. We report a case of subacute cutaneous lupus erythematosus (SCLE) that transitioned into systemic lupus erythematosus (SLE) following AdV-vaccination with AZD1222.A 62-year-old woman presented with a generalized morbilliform exanthema and new onset of fatigue and musculoskeletal pain (Fig. 1). Six months before the first visit to our department, the patient had experienced erythematosquamous papules and plaques symmetrically located in the sun-exposed areas (chest, upper back, lower arms, and dorsal hands). Laboratory investigations found a normal blood cell count and serum chemistry, but increased titres for antinuclear antibodies (1 : 320; normal <1 : 160) and positivity for anti-Ro/SSA(60) antibodies. All other extractable nuclear antigens were unremarkable. Further

Cutaneous Adverse Reactions Associated with SARS-CoV-2 Vaccines

“…Other conditions potentially worsened by the COVID-19 vaccination are atopic dermatitis [6,20,42], lichen ruber planus [6], chronic spontaneous urticaria [64], bullous pemphigoid [65], pemphigus vulgaris [65], pityriasis rubra pilaris [66], urticarial vasculitis, cutaneous small-vessel vasculitis [67], erythema multiforme [68], and Darier's disease [69]. Finally, one case of transition from subacute cutaneous lupus erythematosus into systemic lupus erythematosus was also described [70]. Some cases of radiation recall that the phenomenon was reported 5 to 6 days after the mRNA and adenovirus-vectored vaccines.…”

Pansclerotic Morphea Following COVID-19: A Case Report and Review of Literature on Rheumatologic and Non-rheumatologic Dermatologic Immune-Mediated Disorders Induced by SARS-CoV-2

“…COVID-induced collagen-vascular diseases are presented in Table 2 , and other COVID-induced skin diseases in Table 3 . It should be noted that COVID-19 vaccination might have some similar effects on immune system responses and cause autoimmune diseases, as there have been some reports to date ( 14 , 15 ). Therefore, similar reviews of literature and more investigations on that topic are recommended.…”

Understanding the Concept of Pre-Clinical Autoimmunity: Prediction and Prevention of Systemic Lupus Erythematosus: Identifying Risk Factors and Developing Strategies Against Disease Development

“…However, the evidence is from mainly case reports or cross-sectional studies demonstrating a temporal association. There have also been a few case reports of SLE and lupus nephritis 1-2 weeks following COVID-19 vaccination (192)(193)(194). Without more substantive evidence, however, individuals should be encouraged to get vaccinated as it remains one of the most effective interventions to prevent COVID-19 infection and related morbidity and mortality.…”