Sex: M
Vaccine: COVID19
Symptoms: Imaging procedure, Investigation, Platelet count, White blood cell count
Clinical narrative: potential association between COVID-19 vaccination and cutaneous T-cell lymphoid infiltrates; This is a literature report for the following literature source(s).  A 71-year-old male with history of diabetes and hypertension presented with altered mental status and acute on chronic confluent purpura and crusted plaque over the full body, including his tongue and palate. The onset of his intermittent and progressively worsening rash coincided with receiving the Pfizer COVID-19 vaccine one year prior. Despite initial biopsies indicating atopic dermatitis and subsequent treatments, the rash recurred a few months later, requiring hospitalization at an outside hospital for further evaluation for rheumatologic and malignant etiologies, all of which were initially negative. On current admission, there was concern for sepsis given elevated lactate of 9 mmol/L, mild leukocytosis of 12 K/cumm, thrombocytopenia 108 K/cumm, and tachycardia. Imaging studies demonstrated evidence of esophagitis, COPD, and diverticulitis, but none which explained the severity of the current presentation. Given the complexity of the case, a multidisciplinary team comprising of hematologist, rheumatologist, dermatologist, and infectious disease specialists were assembled to help determine the underlying etiology of his presentation. The differential diagnosis included Stevens-Johnson syndrome, toxic epidermal necrolysis, pemphigus vulgaris, and vasculitis to name a few. He was supported in the ICU while receiving antibiotics, vasopressors, and fluid resuscitation. Unfortunately, patient continued to deteriorate, progressing to purpura fulminans in setting of critical illness, DIC/coagulopathy, and septic shock. Patient passed prior to the result of the skin biopsy, which unveiled primary cutaneous gamma-delta T cell lymphoma with Ki67 IHC stain of 90%. effectively cinching at the diagnosis and prognosis. Lastly, the potential association between COVID-19 vaccination and cutaneous T-cell lymphoid infiltrates warrants further investigation. There have been few incidences of cutaneous T-cell lymphoma and T-cell lymphoid hyperplasia occurring within 10 days of vaccination in otherwise healthy people. Due to the robust immune response triggered by COVID-19 vaccination and/or infection, there are speculations about its potential role in rare T-cell clonal proliferation, possibly leading to lymphoma or hyperplasia. DISCUSSION: Identifying CTCL can be challenging due to its rarity, the resemblance of early-stage symptoms to benign rashes, and the frequent need for multiple biopsies before reaching a conclusive diagnosis. This highlights the importance of having a broad differential diagnosis for skin lesions and high level of clinical suspicion, as well as collaborative efforts among multidisciplinary specialists to achieve early detection, timely intervention, and improved patient outcomes. Although the correlation between the COVID-19 vaccine and cutaneous T-cell lymphoid infiltrates remains uncertain, further research and time may provide more insight into their potential link.; Sender's Comments: Based on the available information and close temporal relationship, the relationship between the event Cutaneous T-cell lymphoma and the suspect drug 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. ; Reported Cause(s) of Death: potential association between COVID-19 vaccination and cutaneous T-cell lymphoid infiltrates