Pfizer/BioNTech‐associated perniosis in two young adults with re‐challenge evidence
Notice bibliographique
Résumé
The employment of novel mRNA delivery with Pfizer/BioNTech (BNT162b2) and Moderna (mRNA-1273) SARS-CoV-2 vaccines has cultivated close scrutiny for adverse events. The novel immunogenic nature of the SARS-CoV-2 virus and its peculiar cutaneous clinical sequelae has further compounded this behaviour. Authors of the American Academy of Dermatology (AAD) and the International League of Dermatological Societies (ILDS) recently published a registry demonstrating a breadth of cutaneous reactions related to the mRNA vaccines.1 Unsurprisingly, the most frequent is local injection site reactions, seen also in Bogdanov et al.,2 but the degree of atypical adverse events, such as erythromelalgia in 6%,1 is striking. Chilblains, or perniosis, are an infrequent reaction in this registry of 414 patients; it was seen eight times as frequently in Pfizer/BioNTech vaccination (8.8%) than amongst patients who received Moderna (1.1%). In contrast, in the setting of natural infection from a registry of 716 patients from 31 countries, up to 18% and 33% of patients with either a confirmed or suspected natural infection, respectively, developed a pernio-like reaction; in the setting of natural infection in this registry, and it was the second most common COVID-19-associated dermatologic manifestation.3 We report two cases of Pfizer/BioNTech vaccine-associated chilblains in previously healthy patients, both with re-challenge evidence and negative viral nasopharyngeal detection. The 31- and 33-year-old men developed lower extremity dorsal acral and periungual pruritus as well as slight tenderness with erythema and oedema at days 5 and 7 following their first vaccine dose. In both cases, the erythema, pruritus and slight tenderness subsided almost entirely by the second dose (28 days later). However, 24-h following their second dose, both had a recurrence of symptoms; in one case, this proceeded to the point of ulceration (Fig. 1). Natural resolution was achieved within 6 weeks in both patients with no residual skin or neurovascular changes. The Naranjo Algorithm was used to score the probability of an adverse drug reaction, which yielded a score of 6 (probable) in both cases.4 The morphological findings in vaccine-induced chilblains appear indistinguishable from idiopathic perniosis and that associated with autoimmune connective tissue disease (AiCTD) with accompanying histologic lymphocytic vasculitis.5 Both the Pfizer/BioNTech and Moderna (mRNA-1273) vaccines encode spike protein antigens with a very high degree of similarity between the generated antibody responses targeted at epitopes from the receptor-binding domain.6 While both cases reported here were secondary to the Pfizer/BioNTech vaccine, as well as those reported by McMahon et al.1 (n = 2) and Lesort et al.7 (n = 1), we suspect that this cutaneous adverse event is not limited to Pfizer/BionTech, but instead represents a phenomenon of immunogenic response; further work is needed to better understand the pathogenesis and relevance to systemic immunity. In conclusion, we report two cases of SARS-CoV-2 perniosis associated with mRNA Pfizer/BioNTech vaccine, which recurred with re-challenge and were self-limited. Vaccine-related perniosis appears to be an indolent cutaneous reaction, which abates in short term, but further documentation and awareness are needed to understand the natural history in larger case numbers. The patients in this manuscript have given written informed consent to the publication of their case details. None. None. Not applicable, and no new data were generated.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,004 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».