Erythema Multiforme After Pfizer and Moderna COVID-19 mRNA Vaccines
Papers Reviewed
2023 Feb (Karatas et al) – Erythema multiforme reactions after Pfizer/BioNTech (BNT162b2) and Moderna (mRNA-1273) COVID-19 vaccination: A case series
- CASE 1: 61M had 1st dose Moderna 10 days before onset of symptoms
- Physical examination (P/E) revealed scattered, non-tender, erythematous, targetoid plaques on the face, trunk, and extremities, including the palms and soles
- also had bilateral conjunctival erythema with multiple vesicles and erosions in the oral mucosa
- Diagnosis; EM major with extensive oral and nasal involvement
- CASE 2: 21F had 2nd dose of Pfizer mRNA 3 days prior
- Presented with rash on hands and feet, swelling and joint discomfort
- She was diagnosed with EM, put on steroids and rash resolved
- CASE 3: 50M had 2nd Pfizer mRNA dose 5 days prior onset of symptoms
- Presented with worsening rash and pruritus for 4 days.
- had erythematous targetoid plaques on trunk and extremities and hemorrhagic crusts on oral mucosa
- was diagnosed with EM and put on prednisone taper and also topical steroid
- CASE 4: 53F had 2nd Moderna mRNA dose 2 days prior to onset
- presented with a 3 week history of rash and pruritus on hands, arms and legs
- P/E: erythematous targetoid plaques on hands and extremities, no mucosal involvement.
- Diagnosed with EM and treated with topical steroid.
- pathogenic mechanism of EM after infection is thought to be a cell-mediated immune reaction with activation of T helper cells and cytokine production,resulting in a robust mucocutaneous inflammatory response.
- The mechanism of EM after vaccination is not entirely clear, but it is likely to be a similar mechanism
- CASE 2: 15M had 1st Pfizer mRNA dose 7 days prior
- developed oral erythema, erosions, and pseudo-membranes throughout the oral mucosa, associated with severe pain and dysphagia
- CASE 3 – 49F had 2nd Pfizer mRNA dose 24 hours prior to onset
- presented with erythematous and bullous like lesions on tongue and mouth floor
- CASE 4: 20F had 1st dose of Pfizer mRNA 18 days prior
- presented with pain and bleeding from the mouth, dysphagia and dysphonia
- P/E: erosions on the gingival and lips mucosa, squamous crusted lesions on the labial skin and vermillion
2021 Nov (Burlando et al) – Cutaneous reactions to COVID-19 vaccine at the dermatology primary care
- 21 patients were referred to Dermatology Clinic with skin reactions after COVID-19 Vaccination
- One patient our of 21 (67 year old man), 48 hours after the second dose of Moderna vaccine, developed a bullous erythema multiforme, which required hospitalization
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Dr. William Makis is a Canadian physician with expertise in Radiology, Oncology and Immunology. Governor General’s Medal, University of Toronto Scholar. Author of 100+ peer-reviewed medical publications.
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