PMC9577074_01
(a) New onset ill-defined erythematous pruritic patches on the back following
first dose of Pfizer COVID-19 vaccine. (b) New onset moderately ill-defined
erythematous pruritic patches on the lower legs following second dose of Moderna
COVID-19 vaccine.
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A 56-year-old woman presented with new erythematous pruritic patches on her buttocks and thighs (Figure 1) that developed within 48 hours after receiving her first dose of the Pfizer-BioNTech COVID-19 vaccine on May 19th 2021. The patient received her second dose of the Moderna COVID-19 vaccine on July 15th 2021, and within 48 hours, developed a similar appearing rash involving her back and lower legs (Figure 1).
Shave biopsy of the right buttock. (a) Band of superficial perivascular
lymphocytic inflammation of the superficial dermis with atypia with junctional
tagging, compact keratin and subtle spongiosis. (b) Scattered lymphocytes with
irregular nuclear contours. (c) CD4 staining. (d) CD8 staining.. CD4: CD8 ratio of T-cell infiltrate was within normal limits with predominant CD8
staining. Image credits to Dr Scott Bradshaw.
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Pathology showed a band of superficial perivascular lymphocytic inflammation of the superficial dermis with atypia (Figure 2(a)). Junctional tagging, compact keratin, subtle spongiosis and scattered lymphocytes with irregular nuclear contours (Figure 2(b)) were observed. The CD4: CD8 ratio of T-cell infiltrate was within normal limits with predominant CD8 staining (Figure 2(c) and (d)).