Age: 53.0
Sex: M
Vaccine: COVID19
Symptoms: Biopsy skin, C-reactive protein, Histology, Physical examination, Psoriasis
Clinical narrative: Worsening of pre-existing plaque psoriasis after the first dose of the Moderna COVID-19 vaccine, with a flare beginning on the neck; This literature-non-study case was reported in a literature article and describes the occurrence of PSORIASIS (Worsening of pre-existing plaque psoriasis after the first dose of the Moderna COVID-19 vaccine, with a flare beginning on the neck) in a 53-year-old male patient who received mRNA-1273 (Spikevax) for COVID-19 prophylaxis.   LITERATURE REFERENCE:     Concurrent medical conditions included Plaque psoriasis (Patient had a 14-years history of psoriasis that was stable prior to vaccination.).   On an unknown date, the patient received first dose of mRNA-1273 (Spikevax) (unknown route) 1 dosage form. On an unknown date, received second dose of mRNA-1273 (Spikevax) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced PSORIASIS (Worsening of pre-existing plaque psoriasis after the first dose of the Moderna COVID-19 vaccine, with a flare beginning on the neck) (seriousness criterion hospitalization). The patient was hospitalized for 5 days due to PSORIASIS. The patient was treated with TRIAMCINOLONE for Erythrodermic psoriasis, at a dose of UNK UNK, qd; TRIAMCINOLONE for Erythrodermic psoriasis, at a dose of UNK UNK, qd; CLOBETASOL PROPIONATE (CLOBETASOL 0.05%) for Erythrodermic psoriasis, at a dose of UNK UNK, qd and IXEKIZUMAB for Erythrodermic psoriasis, at an unspecified dose and frequency. At the time of the report, PSORIASIS (Worsening of pre-existing plaque psoriasis after the first dose of the Moderna COVID-19 vaccine, with a flare beginning on the neck) was resolving.      DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Biopsy skin: superficial epidermal erosion, psoriasiform epidermal hyperplasia, tortuous blood vessels in the papillary dermis, and a mild superficial perivascular lymphocytic infiltrate, consistent with a psoriasiform eruption. On an unknown date, C-reactive protein: Elevated serum C-reactive protein. On an unknown date, Histology: Revealed broad superficial epidermal erosion, psoriasiform epidermal hyperplasia, tortuous blood vessels in the papillary dermis, and a mild superficial perivascular lymphocytic infiltrate. Scattered neutrophils and rare eosinophils were present in the dermal infiltrate. On an unknown date, Physical examination: Revealed numerous scaly erythematous coalescing plaques on a background of diffuse erythema on the trunk and extremities, palmoplantar keratoderma, and nail plate hyperkeratosis and onycholysis. and Diffuse coalescing erythematous scaly plaques on the trunk and extremities with distal onycholysis and hyperkeratotic plaques on the soles bilateral knee, 8 weeks after the second dose of the Moderna COVID-19 vaccine. With estimated 2% body surface area.     For mRNA-1273 (Spikevax) (Unknown), the reporter considered PSORIASIS (Worsening of pre-existing plaque psoriasis after the first dose of the Moderna COVID-19 vaccine, with a flare beginning on the neck) to be related.    No concomitant medication was reported.  Patient treated with topical corticosteroids, ixekizumab and oral antihistamines. Immunosuppressive treatment at time of vaccination was not provided. Patient experienced worsening of pre-existing plaque psoriasis after the first dose of the Moderna COVID-19 vaccine and erythrodermic psoriasis after second dose of Moderna COVID-19 vaccine.  Patient suffered from full body rash with exfoliation, pruritus, endorse significant skin desquamation with pruritus, chills, scale and erythema, and scaly papules.  Patient was admitted to the intensive care unit for a full body rash with exfoliation and pruritus. The patient had received the second dose of the Moderna COVID-19 vaccine 4 weeks prior.   The patient's pre-existing plaque psoriasis worsened after the first dose of the Moderna COVID-19 vaccine, with a flare begun on the neck. Two weeks after the Moderna second dose, that rash had spread to the entire body. The patient denied any preceded medication changes or other precipitating factors.   Three weeks later, the patient reported mild improvement but continued to endorse significant skin desquamation with pruritus and chills. Marked improvement with distal onycholysis on the bilateral fingernails following 8-week treatment with ixekizumab. Patient was reported that mild improvement at 4 weeks and significant improvement at 14 weeks.   Most recent FOLLOW-UP information incorporated above includes: On 07-Oct-2022: Follow up received by safety on 07-Oct-2022 has Email and contains significant information: Reporter information, literature citation details, lab data, treatment drugs, additional event added, event outcome and causality were updated and case upgraded to serious.  Company Comment: This is a Literature-non-study case concerning a 53-year-old male patient, with relevant medical condition of plaque psoriasis, who experienced the unexpected and serious (due to hospitalization) event of Erythrodermic psoriasis and Psoriasis. Patient´s pre-existing plaque psoriasis worsened after the first dose of mRNA-1273 vaccine, with a flare beginning on the neck. 2 weeks after the second dose of mRNA-1273, this rash had spread to the entire body. Labs were notable for an elevated C-reactive protein. Patient was admitted for 5 days in the intensive care unit, and treated with clobetasol 0.05% ointment daily and oral antihistamines. 3 weeks later, patient reported mild improvement, but continued to endorse significant skin desquamation with pruritus and chills. Physical examination revealed numerous scaly erythematous coalescing plaques on a background of diffuse erythema on the trunk and extremities, palmoplantar keratoderma, and nail plate hyperkeratosis and onycholysis. Estimated body surface area was 95%. A punch biopsy demonstrated a patron consistent with a psoriasiform eruption. Treatment with triamcinolone 0.1% ointment daily under occlusion for 2 weeks led to marked improvement. Subsequently, the patient was started on ixekizumab. 8 weeks later, examination revealed few well-demarcated scaly papules and plaques on the bilateral knees with estimated 2% body surface area. Underlying plaque psoriasis could be a confounder for this case. The benefit-risk relationship of mRNA- 1273 vaccine is not affected by this report. Sender's Comments: This is a Literature-non-study case concerning a 53-year-old male patient, with relevant medical condition of plaque psoriasis, who experienced the unexpected and serious (due to hospitalization) event of Erythrodermic psoriasis and Psoriasis. Patient´s pre-existing plaque psoriasis worsened after the first dose of mRNA-1273 vaccine, with a flare beginning on the neck. 2 weeks after the second dose of mRNA-1273, this rash had spread to the entire body. Labs were notable for an elevated C-reactive protein. Patient was admitted for 5 days in the intensive care unit, and treated with clobetasol 0.05% ointment daily and oral antihistamines. 3 weeks later, patient reported mild improvement, but continued to endorse significant skin desquamation with pruritus and chills. Physical examination revealed numerous scaly erythematous coalescing plaques on a background of diffuse erythema on the trunk and extremities, palmoplantar keratoderma, and nail plate hyperkeratosis and onycholysis. Estimated body surface area was 95%. A punch biopsy demonstrated a patron consistent with a psoriasiform eruption. Treatment with triamcinolone 0.1% ointment daily under occlusion for 2 weeks led to marked improvement. Subsequently, the patient was started on ixekizumab. 8 weeks later, examination revealed few well-demarcated scaly papules and plaques on the bilateral knees with estimated 2% body surface area. Underlying plaque psoriasis could be a confounder for this case. The benefit-risk relationship of mRNA- 1273 vaccine is not affected by this report.