Bullous pemphigoid after SARS‐CoV‐2 vaccination: spike‐protein‐directed immunofluorescence confocal microscopy and T‐cell‐receptor studies
Bibliographic record
Abstract
Dear Editor, Growing evidence suggests that SARS‐CoV‐2 vaccination is associated with a variety of cutaneous reactions. These include autoimmune‐mediated conditions such as autoimmune blistering diseases (AIBDs), one of which is bullous pemphigoid (BP).1, 2 We report new‐onset BP in two patients following their first SARS‐CoV‐2 vaccination. The first patient was an 80‐year‐old man who noticed reddish itchy macules with small blisters on his lower legs 1 week after vaccination with BTN162b2.2 Two weeks later, after he had received his second shot, these erythematous/bullous lesions spread over his trunk (Figure 1a). The second patient was an 89‐year‐old man who noticed 2 days after the first BTN162b2 vaccination itchy erythematous/bullous lesions on his entire integument. Neither of the patients reported intake of any new medications or other newly diagnosed conditions prior to the AIBDs. In both cases, subepidermal clefts were demonstrated on routine histology (Figure 1b). In both patients, direct immunofluorescence on frozen sections revealed linear deposits of IgG and C3 at the basement membrane zone. Indirect immunofluorescence showed bandlike IgG deposits on the epidermal side in both patients. In both cases, enzyme‐linked immunosorbent assay revealed highly elevated autoantibody levels against BP‐180 (365 U mL−1 and 115 U mL−1, normal range < 20) and BP‐230 (223 U mL−1 and 41 U mL−1, normal range < 20). Hence, both patients were diagnosed with BP. Both were successfully treated with a tapered systemic prednisolone regimen.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.008 | 0.004 |
| Insufficient payload (model declined to judge) | 0.003 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".