New Onset Bullous Pemphigoid After COVID-19 Inactivated Virus Vaccination: A Case Report
Keywords:
bullous pemphigoid, covid-19 vaccination, inactivated virus, SARS-COV-2Abstract
Bullous pemphigoid (BP) is an autoimmune bullous disease caused by circulating immunoglobulins G (IgG) against hemidesmosome antigens commonly found in elderly patients. Pemphigoid cases have been reported in association with vaccination. Cases of subepidermal blistering eruptions including BP had also been reported after COVID-19 vaccination. Here we report a case of an elderly woman who developed BP after receiving SARS-CoV-2 inactivated virus vaccine. She was presented to our hospital with a pruritic blistering eruption which started 10 days after her second dose of SARS-CoV-2 inactivated virus vaccine. She had a history of pruritic redness skin lesions on her arms and legs that appeared seven days after her first dose of vaccine. Histopathology and direct immunofluorescence examination were suggesting BP. Symptoms were improved after oral and topical corticosteroid treatment. The timeline of vaccination and appearance of blistering skin lesions suggesting possible association between BP and COVID-19 vaccination. We should be aware that the onset or flare-up of BP can occur after vaccination in the elderly.References
Bernard P, Antonicelli F. Bullous Pemphigoid: A Review of its Diagnosis, Associations and Treatment. Am J Clin Dermatol. 2017;18(4):513–28.
Lo Schiavo A, Ruocco E, Brancaccio G, et al. Bullous pemphigoid: Etiology, pathogenesis, and inducing factors: Facts and controversies. Clin Dermatol. 2013;31(4):391–9.
Moro F, Fania L, Sinagra JLM, et al. Bullous pemphigoid: Trigger and predisposing factors. Biomolecules. 2020;10(10):1–29.
Kasperkiewicz M, Woodley DT. Association between vaccination and autoimmune bullous diseases: A systematic review. J Am Acad Dermatol. 2021;S0190-9622.
Ophinni Y, Hasibuan AS, Widhani A, et al. COVID-19 Vaccines: Current Status and Implication for Use in Indonesia. Acta Med Indones. 2020;52(4):388–412.
Tomayko MM, Damsky W, Fathy R, et al. Subepidermal blistering eruptions, including bullous pemphigoid, following COVID-19 vaccination. J Allergy Clin Immunol. 2021;148(3):750–1.
Damiani G, Pacifico A, Pelloni F, et al. The first dose of COVID-19 vaccine may trigger pemphigus and bullous pemphigoid flares: is the second dose therefore contraindicated? J Eur Acad Dermatology Venereol. 2021;35(10):e645–7.
Chen X, Zhao W, Jin H, et al. Risk Factors for Mucosal Involvement in Bullous Pemphigoid and the Possible Mechanism: A Review. Front Med. 2021;8:1–8.
Borba VV, Kanduc D, Shoenfeld Y. Bullous Pemphigoid Following HBV Vaccine: from Case Reports to a Mosaic of Molecular Evidence. Arch Nutr Public Heal. 2019;1(1):1–8.
Pacheco Y, Acosta-Ampudia Y, Monsalve DM, et al. Bystander activation and autoimmunity. J Autoimmun. 2019;103:102301.
Rojas M, Restrepo-Jiménez P, Monsalve DM, et al. Molecular mimicry and autoimmunity. J Autoimmun. 2018;95:100–23.
Pérez-López I, Moyano-Bueno D, Riuz-Villaverde R. Bullous pemphigoid and COVID-19 vaccine. Med Clin (Barc). 2021;157(210):e333-334.
Walmsley N, Hampton P. Bullous pemphigoid triggered by swine flu vaccination: Case report and review of vaccine triggered pemphigoid. J Dermatol Case Rep. 2011;5(4):74–6.
Goronzy JJ, Li G, Yang Z, et al. The janus head of T cell aging-autoimmunity and immunodeficiency. Front Immunol. 2013;4:131.
Gao Q, Bao L, Mao H, et al. Development of an inactivated vaccine candidate for SARS-CoV-2. Science (80- ). 2020;369(6499):77–81.
Olivieri B, Betterle C, Zanoni G. Vaccinations and autoimmune diseases. Vaccines. 2021;9(8):1–15.
Afacan E, Edek YC, İlter N, et al. Can Covid-19 vaccines cause or exacerbate bullous pemphigoid? A report of seven cases from one center. Int J Dermatol. 2022;1–2.
