Sex: F
Vaccine: COVID19
Symptoms: Pemphigus
Clinical narrative: pemphigus vulgaris (mouth); This is a literature report.  A 40-year-old female patient received BNT162b2 (BNT162B2), as dose 1, single (Batch/Lot number: unknown) for covid-19 immunisation. The patient's relevant medical history and concomitant medications were not reported. The following information was reported: PEMPHIGUS (medically significant), 5 days after the suspect product(s) administration, outcome "recovering", described as "pemphigus vulgaris (mouth)". Therapeutic measures were taken as a result of pemphigus. The patient received oral prednisone and azathioprine as treatment.  Clinical Course: Pemphigus Vulgaris (PV) is a rare autoimmune skin blistering disorder. there have been previous reports of COVID-19 triggering autoimmune responses, including PV.1 However, there remains limited discussion on the incidences of PV after COVID-19 infection and vaccination. We present a review of PV onset after COVID-19 infection and vaccination and its implications for shared clinical decision making between patients and clinicians. Literature searches were conducted on internet ranging from 2019 to December 2021. Five articles were selected on the basis of subject relevance cases of PV flares were excluded. To date (February 2022), there have been 3 cases of PV after COVID-19 vaccination and 1 case of PV after COVID-19 infection.It is hypothesized that the Moderna mRNA-1273 vaccine upregulates T celledependent production of interleukin (IL) 17, interferon, and tumor necrosis factor ? cytokines to mediate PV. Meanwhile, the mRNA BNT162b2 (Pfizer) vaccine indirectly upregulates the production of IL-4, IL-17, and IL-21 cytokines that have been implicated in autoimmune disorders, including PV. Finally, the double stranded DNA inside the AZD1222 (AstraZeneca) adenovirus vector vaccine activates toll-like receptor 9, which subsequently upregulates the production of type I interferons that may induce PV-related autoimmunity. However, reports have disputed these hypotheses that vaccine developers have added stabilizing adjuvants and removed interferon stabilizing double stranded messenger RNA from the final preparations to reduce the risk of stimulating autoimmune reactions. For PV onset after COVID-19 infection, it is hypothesized that the development of PV after COVID-19 infection could be triggered by molecular mimicry, by stander activation, epitope spreading, or a combination of these 3 autoimmune phenomena. PV has been reported very rarely after COVID-19 infection and vaccination. The benefits of COVID-19 vaccines significantly outweigh the risks, particularly for the patient population with PV because of their heightened risk of COVID-19 infection and severe complications, such as long-term health impairments and death. We recommend that health care providers discuss the risks and benefits of receiving the COVID-19 vaccine with sensitivity and transparency and remain vigilant against the rare but severe risk of post vaccination PV onset.; Sender's Comments: Based on the available reported information, the causal association between the event pemphigus and the suspect drug BNT162B2 cannot be excluded. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.,Linked Report(s) : US-PFIZER INC-202201169919 Same article/ drug/ patient and different event;US-PFIZER INC-202201169919 Same article/ drug/ patient and different event;