Sex: M
Vaccine: COVID19
Symptoms: Histology, Leukocytosis, Malaise, Neutrophil count, Pustule
Clinical narrative: acute localized exanthematous pustulosis; patient noticed swelling, predominantly of the central face and eye lids; patient noticed swelling, predominantly of the central face and eye lids; weakness; malaise; subjective fevers; Tachycardia; leukocytosis with neutrophil dominance; pain in face and eyelids; facial erythema; erythematous, edematous plaques spanning the eyelids, cheeks, and nasal dorsum; monomorphic submillimeter follicularly based pustule; crust emerged within the erythema; facial eruption; This literature-non-study case was reported in a literature article and describes the occurrence of ACUTE GENERALISED EXANTHEMATOUS PUSTULOSIS (acute localized exanthematous pustulosis) in an elderly male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below.      No Medical History information was reported.   On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient experienced ACUTE GENERALISED EXANTHEMATOUS PUSTULOSIS (acute localized exanthematous pustulosis) (seriousness criterion medically significant), SWELLING OF EYELID (patient noticed swelling, predominantly of the central face and eye lids) and SWELLING FACE (patient noticed swelling, predominantly of the central face and eye lids). an unknown date, the patient experienced ASTHENIA (weakness), MALAISE (malaise), PYREXIA (subjective fevers), TACHYCARDIA (Tachycardia), LEUKOCYTOSIS (leukocytosis with neutrophil dominance), FACIAL PAIN (pain in face and eyelids) and RASH (facial eruption). an unknown date, the patient experienced ERYTHEMA (facial erythema), SKIN PLAQUE (erythematous, edematous plaques spanning the eyelids, cheeks, and nasal dorsum), PUSTULE (monomorphic submillimeter follicularly based pustule) and SCAB (crust emerged within the erythema). The patient was treated with VANCOMYCIN for Adverse event, at an unspecified dose and frequency; PIPERACILLIN SODIUM, TAZOBACTAM SODIUM (PIPERACILLIN/TAZOBACTAM) for Adverse event, at an unspecified dose and frequency; TACROLIMUS for Adverse event, at a dose of 0.1 percent and DOXYCYCLINE for Adverse event, at an unspecified dose and frequency. At the time of the report, ACUTE GENERALISED EXANTHEMATOUS PUSTULOSIS (acute localized exanthematous pustulosis), SWELLING OF EYELID (patient noticed swelling, predominantly of the central face and eye lids), SWELLING FACE (patient noticed swelling, predominantly of the central face and eye lids), ASTHENIA (weakness), MALAISE (malaise), PYREXIA (subjective fevers), TACHYCARDIA (Tachycardia), LEUKOCYTOSIS (leukocytosis with neutrophil dominance), FACIAL PAIN (pain in face and eyelids), ERYTHEMA (facial erythema), SKIN PLAQUE (erythematous, edematous plaques spanning the eyelids, cheeks, and nasal dorsum), PUSTULE (monomorphic submillimeter follicularly based pustule), SCAB (crust emerged within the erythema) and RASH (facial eruption) had resolved.      DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Bacterial test: negative (Negative) Bacterial culture from a pustule did not reveal a causative organism. On an unknown date, Histology: interstitial and intrafollicular infiltrate (abnormal) Interstitial and intrafollicular infiltrate composed mostly of neutrophils with some admixed lymphocytes and plasma cells that are present in the superficial and deep dermis. Also showed follicular dilatation, plugging and neutrophils with prominent involvement of hair follicles.. On an unknown date, Neutrophil count: high (High) High.     For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter considered ACUTE GENERALISED EXANTHEMATOUS PUSTULOSIS (acute localized exanthematous pustulosis), SWELLING OF EYELID (patient noticed swelling, predominantly of the central face and eye lids), SWELLING FACE (patient noticed swelling, predominantly of the central face and eye lids), ASTHENIA (weakness), MALAISE (malaise), PYREXIA (subjective fevers), TACHYCARDIA (Tachycardia), LEUKOCYTOSIS (leukocytosis with neutrophil dominance), FACIAL PAIN (pain in face and eyelids), ERYTHEMA (facial erythema), SKIN PLAQUE (erythematous, edematous plaques spanning the eyelids, cheeks, and nasal dorsum), PUSTULE (monomorphic submillimeter follicularly based pustule), SCAB (crust emerged within the erythema) and RASH (facial eruption) to be possibly related.    Concomitant product use was not provided by the reporter.  The abrupt onset of facial erythema, edema, and pustules may be consistent with rosacea fulminans, although the lack of nodules, papules, and cysts and occurrence in 2 older men go against that diagnosis. It was unclear if that facial eruption in the setting of the mRNA-1273 vaccine represents a distinct entity or an unmasking of a dermatologic condition in a predisposed individual. It was also notable that for patient 2, the eruption occurred after the second dose only, which had been reported elsewhere.  Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. This case is from a literature review.   This case was linked to MOD-2021-273868 (Patient Link).; Sender's Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. This case is from a literature review.