key: cord-0858786-uhevvabq
authors: Song, Eingun James; Wong, Audrey Jia Shin
title: Widespread annular eruption after Johnson & Johnson COVID-19 Vaccine
date: 2021-05-12
journal: JAAD Case Rep
DOI: 10.1016/j.jdcr.2021.04.032
sha: 6530807150d190507a08b5f7b7a4b9a95c87325e
doc_id: 858786
cord_uid: uhevvabq

nan

have also received emergency use authorization, local and systemic side effects were common 34 and seen in over 50% of patients 1 . Rashes other than injection site reactions and delayed 35 hypersensitivity reactions, now known as "COVID arm", were not even reported according to 36 J&J's phase 3 interim analysis. In fact, other than 5 reported cases of urticaria, there were no 37 actual reports of "rash" or "dermatitis" 2 . 38 39 On March 5, 2021, a 74-year-old male who received the J&J COVID-19 vaccine developed a 40 severe widespread morbilliform eruption four days later that required prolonged 41 hospitalization 3 . His case is currently being submitted to a medical journal but there is currently 42 a paucity of data on skin eruptions from the J&J COVID-19 vaccine. We report the case of an 83-43

year-old woma n who developed a widespread erythematous annular eruption that resolved 44 after a week with antihistamines and mid-potency topical steroids. appear on the breast, abdomen and axilla (figure 1). When she presented to our clinic one week 49 later, she had more widespread disease and her prior sites of involvement had developed 50 scattered petechiae (figure 2). She denied any oral or genital involvement and she otherwise 51 felt well. She denied any prior history of COVID-19 and her review of systems were negative for 52 fever, chills, body aches, sore throat and diarrhea. Her past medical history included 53 hypertension, hypothyroidism and breast cancer. There were no recent changes in her 54 medications which included palbociclib, letrozole and vitamin D. She did not take any over-the-55 counter medications or herbal supplements. The patient denied any previous history of 56 persistent skin rash, allergies or autoimmune disease. 57 58 A representative lesion was biopsied which showed a mixed spongiotic and interface dermatitis 59 with rare eosinophils and extravasated erythrocytes (figure 3). The patient was started on 60 fexofenadine 360mg daily, cetirizine 20mg nightly and triamcinolone 0.1% cream twice daily. 61

One week later, the patient reported she was no longer getting new lesions and her pruritus 62 had nearly resolved. At her 2-week follow-up, the patient was completely clear except for 63 some residual post-inflammatory erythema and all treatment was discontinued ( figure 4) . 64

The cutaneous manifestations of COVID-19 have now been well documented and include 66 morbilliform, urticarial, petechial, varicelliform, vasculopathic and chilblain-like eruptions 4 . Less 67 is known about the cutaneous adverse reactions to the COVID-19 vaccine and mostly come 68 from anecdotal reports. We hope that our case will contribute to the current dearth of clinical 69 data on cutaneous adverse events from the COVID-19 vaccines. Furthermore, we strongly 70 encourage all clinicians to report any adverse events from the COVID-19 vaccines so that we 71 could better counsel and care for our patients 5 . In conclusion, we report a case of a widespread 72 annular eruption that developed 48 hours after administration of the J&J COVID-19 vaccine 73 which resolved with antihistamines and mid-potency topical steroids. 74 J o u r n a l P r e -p r o o f Eosinophil tagging is not seen at the dermoepidermal junction. There is moderate edema in the 97 papillary dermis. There is a moderate superficial perivascular and interstitial infiltrate of 98 lymphocytes with a small number of eosinophils and a few extravasated erythrocytes. 99 

Systemic Reactions, Adverse Events, and Serious Adverse Events

Accessed April 3, 2021. 79 2. Biotech J. Vaccines and Related Biological Products Advisory Committee

Cutaneous manifestations in COVID-19: 85 Lessons learned from current evidence

VAERS -Report an Adverse Event