https://doi.org/10.4081/reumatismo.2022.1475
Erythema nodosum after COVID-19 vaccine
Submitted: 5 December 2021
Accepted: 25 February 2022
Published: 3 May 2022
Accepted: 25 February 2022
Abstract Views: 2322
PDF: 700
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
The current coronavirus disease 2019 (COVID-19) pandemic is a global challenge with strong medical and socioeconomic implications. Hopes have been placed in the development of various vaccines. As the vaccination campaign is in progress, adverse effects need to be monitored closely. Possible side effects range from minor events to more serious manifestations. In this article, we describe two cases of erythema nodosum (EN) after COVID-19 vaccination in two previously healthy female patients of 59 and 51 years, respectively. Most of the usual etiologies of EN were excluded by laboratory testing. EN was successfully treated with corticosteroids. Remarkably, in the first case, a relapse occurred 48 hours after the second dose of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. In this case series, we describe two unusual occurrences of EN after vaccination with an mRNA COVID-19 vaccine and a viral vector vaccine, respectively, and we discuss the available related literature.
Polack FP, Thomas SJ, Kitchin N, et al. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Engl J Med. 2020; 383: 2603-15.
DOI: https://doi.org/10.1056/NEJMoa2034577
McMahon DE, Amerson E, Rosenbach M, et al. Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: A registry-based study of 414 cases. J Am Acad Dermatol. 2021; 85: 46-55.
DOI: https://doi.org/10.1016/j.jaad.2021.03.092
Perez-Garza DM, Chavez-Alvarez S, Ocampo-Candiani J, Gomez-Flores M. Erythema nodosum: a practical approach and diagnostic algorithm. Am J Clin Dermatol. 2021; 22: 367-78.
DOI: https://doi.org/10.1007/s40257-021-00592-w
Suter P, Mooser B, Pham Huu Thien HP. Erythema nodosum as a cutaneous manifestation of COVID-19 infection. BMJ Case Rep. 2020; 13: 7.
DOI: https://doi.org/10.1136/bcr-2020-236613
Sipfle DN, Bridwell Md RE, Roper DJ. Erythema nodosum-like rash in a COVID-19 patient: A case report. Am J Emerg Med. 2021; 40: 227, e1- e2.
DOI: https://doi.org/10.1016/j.ajem.2020.07.063
Ordieres-Ortega L, Toledo-Samaniego N, Parra-Virto A, et al. Atypical erythema nodosum in a patient with COVID-19 pneumonia. Dermatol Ther. 2020; 33: e13658.
DOI: https://doi.org/10.1111/dth.13658
Qin C, Zhou L, Hu Z, et al. Dysregulation of Immune Response in Patients With Coronavirus 2019 (COVID-19) in Wuhan, China. Clin Infect Dis. 2020; 71: 762-8.
DOI: https://doi.org/10.1093/cid/ciaa248
Khan S, Shafiei MS, Longoria C, et al. SARS-CoV-2 spike protein induces inflammation via TLR2-dependent activation of the NF-kappaB pathway. Elife. 2021; 10.
DOI: https://doi.org/10.7554/eLife.68563
Magro CM, Mulvey JJ, Laurence J, et al. Docked severe acute respiratory syndrome coronavirus 2 proteins within the cutaneous and subcutaneous microvasculature and their role in the pathogenesis of severe coronavirus disease 2019. Hum Pathol. 2020; 106: 106-16.
DOI: https://doi.org/10.1016/j.humpath.2020.10.002
McGonagle D, Sharif K, O'Regan A, Bridgewood C. The role of cytokines including interleukin-6 in COVID-19 induced pneumonia and macrophage activation syndrome-like disease. Autoimmun Rev. 2020; 19: 102537.
DOI: https://doi.org/10.1016/j.autrev.2020.102537
Aly MH, Alshehri AA, Mohammed A, et al. First case of erythema nodosum associated with Pfizer vaccine. Cureus. 2021; 13: e19529.
DOI: https://doi.org/10.7759/cureus.19529
Blumenthal KG, Saff RR, Freeman EE. Delayed large local reactions to mRNA vaccines. reply. N Engl J Med. 2021; 384: e98.
DOI: https://doi.org/10.1056/NEJMc2104751
Mehta H, Handa S, Malhotra P, et al. Erythema nodosum, zoster duplex and pityriasis rosea as possible cutaneous adverse effects of Oxford-AstraZeneca COVID-19 vaccine: report of three cases from India. J Eur Acad Dermatol Venereol. 2021 [Epub ahead of print].
DOI: https://doi.org/10.1111/jdv.17678
Cameli N, Silvestri M, Mariano M, et al. Erythema nodosum following the first dose of ChAdOx1-S nCoV-19 vaccine. J Eur Acad Dermatol Venereol. 2021 [Epub ahead of print].
DOI: https://doi.org/10.1111/jdv.17762
Taylor W, Gladman D, Helliwell P, et al. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum. 2006; 54: 2665-73.
DOI: https://doi.org/10.1002/art.21972
De Simone C, Sollena P, Coco V, Caldarola G. Psoriasis and erythema nodosum: two comorbidities of inflammatory bowel diseases. G Ital Dermatol Venereol. 2013; 148: 175-84.
Teymour S, Ahram A, Blackwell T, et al. Erythema nodosum after Moderna mRNA-1273 COVID-19 vaccine. Dermatol Ther. 2022: e15302.
Burlando M, Russo R, Cozzani E, Parodi A. COVID-19 "second wave" and vaccines: the dermatologists' perspective. Int J Dermatol. 2021; 60: 889-90.
DOI: https://doi.org/10.1111/ijd.15547
Maranini B, Ciancio G, Cultrera R, Govoni M. Herpes zoster infection following mRNA COVID-19 vaccine in a patient with ankylosing spondylitis. Reumatismo. 2021; 73: 1445.
DOI: https://doi.org/10.4081/reumatismo.2021.1445
How to Cite
Maranini, B., Ciancio, G., Corazza, M., Ruffilli, F., Galoppini, G., & Govoni, M. (2022). Erythema nodosum after COVID-19 vaccine. Reumatismo, 74(1). https://doi.org/10.4081/reumatismo.2022.1475
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