key: cord-0951876-wmyha45d
authors: Ameri, Maryam; Abolmaali, Meysam; Alwedaie, Sayed Mohammed Jawad; Nabavi, Mohammad; Rahimian, Neda; Hamidabad, Negin Mahmoodi
title: Severe Persistent Eczema in a Recipient of the Gam-COVID-Vac vaccine
date: 2022-01-12
journal: Eur J Case Rep Intern Med
DOI: 10.12890/2022_003042
sha: b005a0803ce6fc466e8276eec1611926491b390f
doc_id: 951876
cord_uid: wmyha45d

Since the beginning of the COVID-19 pandemic, efforts have been made to design safe and effective vaccines against SARS-CoV-2. Numerous vaccines have been designed and tested in limited clinical trials in various countries. Among them, the Sputnik V vaccine has shown a relatively safe profile and, to our knowledge, has no associated major side effects. We describe the case of a 40-year-old female healthcare worker who developed severe persistent eczematous lesions on the second day after she received the first dose of the Sputnik vaccine. The eczematous lesions were refractory to an antihistamine and persisted at the 1 month follow-up. Severe persistent eczematous lesions should be viewed as a potential side effect of vaccination with the Sputnik V vaccine. Moreover, a severe allergic reaction to a COVID-2019 vaccine may indicate the vaccine is ineffective in the recipient. LEARNING POINTS: Vaccination against COVID-19 may be accompanied by rare complications. Eczematous lesions can be a side effect of the Sputnik V vaccine. A severe allergic reaction to a COVID-19 vaccine may result in decreased vaccine effectiveness in the recipient.

Since the announcement of the COVID-19 pandemic by the World Health Organization [1] in March 2020, more than 289 million confirmed cases of COVID-19 and approximately 3 million deaths have been recorded [2] . Efforts have been made to design safe and effective vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [3] . Despite having numerous benefits, vaccines in general are not completely risk free. The most common side-effects are usually minor, but some can cause serious and life-threatening adverse effects that are not clearly identified until the vaccine is in common use [4] . This also applies to the new COVID-19 vaccines which were developed rapidly due to concerns about the high transmissibility and overall mortality rate of SARS-CoV-2. As phase I, II and III trials were combined in order to save time, it is important to identify previously unreported adverse effects in vaccine recipients.

Iran began COVID-19 vaccination on 9 February 2021 using Sputnik V, the world's first registered COVID-19 vaccine. The Moderna, Pfizer-BioNTech (mRNA vaccines) [5, 6] and Sputnik V (rAd26 and rAd5 vector-based vaccine) [7] vaccines all have over 90% efficacy. Sputnik V uses a recombinant adenovirus method (adenovirus 26 and adenovirus 5) to express the SARS-COV-2 spike protein and is currently registered in more than 55 countries [8] . The efficacy of the Sputnik V vaccine is 91.4% by 21 days after the first injection [9] and except in one study where four cases of self-reported anaphylaxis were observed [10] , no other serious adverse reactions have been reported so far [8] . In this case report, we describe a case of severe persistent eczema in a recipient of the Sputnik V vaccine, which developed soon after the first injection.

A 40-year-old woman, with no known illness, presented with a 2-week history of eczematous lesions on the forehead, nasal bridge, cheeks, breasts and upper limbs. The patient had received her first dose of Gam-COVID-Vac (Sputnik V) on 24 February 2021. She immediately experienced low-grade fever and mild myalgia. Fever and myalgia subsided on the second day but eczematous-like skin lesions then developed (Fig. 1) . She took fexofenadine (Telfast) once daily for 2 weeks as a remedy for the skin rash. Her medical history was insignificant and she was not on any medication. She had no history of COVID-19 infection. She reported no previous allergic reactions to any medication or food. There was no family history of any allergic disease. She was non-smoker, did not drink alcohol, works as a forensics doctor in the hospital and has been exposed to COVID-19 patients. Despite consumption of a second-generation antihistamine (fexofenadine) for 2 weeks, the skin rash was sustained on most of her body except for the face (Fig. 2) . 

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