Sex: M
Vaccine: COVID19
Symptoms: Blood bicarbonate, Body temperature, C-reactive protein, COVID-19, SARS-CoV-2 test
Clinical narrative: On day 4, he tested positive for SARS-CoV-2 by nasopharyngeal polymerase chain reaction; On day 4, he tested positive for SARS-CoV-2 by nasopharyngeal polymerase chain reaction; This is a literature report.  A 46-year-old male patient received BNT162b2 (BNT162B2), as dose 1, single (Batch/Lot number: unknown), as dose 2, single (Batch/Lot number: unknown) and as dose 3 (booster), 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: VACCINATION FAILURE (medically significant), COVID-19 (medically significant), outcome "unknown" and all described as "On day 4, he tested positive for SARS-CoV-2 by nasopharyngeal polymerase chain reaction". The patient underwent the following laboratory tests and procedures: Blood bicarbonate (20-30): 19 mmol/L; Body temperature: 38 Centigrade, notes: Fever; C-reactive protein: 276.5 mg/l, notes: normal 10 mg/L; SARS-CoV-2 test: Negative; positive; Serum ferritin (normal low range 30): 1465 ng/ml, notes: 400; Unevaluable investigation: Was negative for cough, notes: sore throat, rhinorrhea, or congestion; Vital signs measurement: Unremarkable. Therapeutic measures were taken as a result of covid-19.  Clinical course: This case was detected in the medical literature. Treatment of toxic epidermal necrolysis and concurrent COVID-19-associated hyperinflammatory syndrome with systemic corticosteroids and etanercept. This spontaneous case was reported in the medical literature by a physician from country and concerns a 46-year-old male patient who experienced a serious adverse reaction of toxic epidermal necrolysis associated with sulfamethoxazole, trimethoprim. The case is of TEN (toxic epidermal necrolysis) and concurrent COVID-19-associated hyperinflammatory syndrome (cHIS) successfully treated with systemic corticosteroids and etanercept. The patient with a history of ascending aortic dissection status post aortic root and aortic valve replacement on warfarin presented with a 2-day history of painful rash. His only new medication was trimethoprim-sulfamethoxazole 160-800 mg twice daily, started 4 days prior to rash onset and discontinued the following day. Two days preceding the rash, he developed a fever to 38 Celsius degree. Review of systems was negative for cough, sore throat, rhinorrhea, or congestion. He was vaccinated and boosted with the BNT162b2 (Pfizer-BioNTech) vaccine. Nasopharyngeal polymerase chain reaction test for SARS-CoV-2 was negative. On admission, his vital signs were unremarkable. His dermatologic examination demonstrated bilaterally injected sclera with yellow-white crusting around the eyelid margins and a 3-cm erosion on the hard palate. Painful red macules coalescing into patches covered 90% of his body surface area, with extensive flaccid bullae creating a "cigarette paper" appearance. Nikolsky sign was positive. Laboratory testing was notable for serum bicarbonate of 19 mmol/L (normal 20-30 mmol/L). Skin biopsy of the right upper back demonstrated an acute basket-woven stratum corneum, widespread, confluent keratinocyte necrosis with focal adnexal involvement, and modest inflammation. The diagnosis based on clinicopathological correlation was TEN, with trimethoprim-sulfamethoxazole as the suspected drug culprit. He was initially treated with a single dose of methylprednisolone 125 mg IV (2 mg/kg prednisone equivalent) and etanercept 50 mg subcutaneously. On day 2, he became febrile with a temperature of 39.3 Celsius degree. On day 4, he tested positive for SARS-CoV-2 by nasopharyngeal polymerase chain reaction. Laboratory testing was notable for C-reactive protein of 276.5 mg/L (normal 10 mg/L) and ferritin of 1465 ng/mL (normal 30-400 ng/mL). On day 5, he began a 5-day course of dexamethasone 6 mg and received a second etanercept dose. On day 6, he received tocilizumab 8 mg/kg IV and began a 5-day course of remdesivir 100 mg. On day 7, he required intubation and mechanical ventilation due to agitated delirium requiring sedation. While intubated, he required low positive end-expiratory pressures and a low fraction of inspired oxygen. Initial reepithelization was observed on day 7. His hospital course was complicated by Pseudomonas bacteremia and Clostridioides difficile colitis, for which he received IV piperacillin-tazobactam and PO vancomycin, respectively. Complete reepithelization was observed by day 15. He was extubated on day 17 and discharged home on day 23. This case report describes the first successful treatment of TEN and concurrent cHIS with systemic corticosteroids and etanercept in the literature. His SCORTEN (Score of Toxic Epidermal Necrolysis) was 3 and the ABCD-10 severity-of-illness score (age, bicarbonate, cancer, dialysis, 10% body surface area) was 2. Follow-up information has been requested.; Sender's Comments: Based on the information given in narrative, the causal relationship between the event and the suspect drug BNT162B2 cannot be excluded.