Sex: M
Vaccine: COVID19
Symptoms: Pityriasis rosea
Clinical narrative: These findings were consistent with pityriasis rosea; This is a literature report.  A 66-year-old male with a history of mild hidradenitis suppurativa presented to his primary care physician due to the development of an ovoid eczematous plaque on his right flank. Over the next week, multiple similar slightly scaling patches and plaques appeared on his back, chest, and abdomen. The patient reported that approximately 1 week prior to the first lesion appearing, he had received the first dose of the PfizerBioNTech COVID-19 vaccine. His only other reported symptom was transient arm soreness. He denied any personal history of a similar rash or any generalized symptoms and reported no recent travel. Physical exam revealed a 3-cm red-brown eczematous plaque on the right flank and multiple two-toned papules with fine over lying scale, following skin cleavage lines in a "tree" distribution on the upper body (Pityriasis rosea (chest, flank, and axilla); pityriasis rosea (back)). There was no mucous membrane involvement. Histopathology showed a superficial perivascular lymphohistiocytic infiltrate with scattered dermal erythrocytes, along with nonspecific chronic dermatitis, spongiosis, absent granular layer, and focal hyperkeratosis and parakeratosis. These findings were consistent with pityriasis rosea. The patient was initially treated with triamcinolone 0.1% ointment as needed for itch, then transitioned to a bland emollient. Four weeks after initial presentation, the patient reported complete resolution of the rash. Discussion: To authors' knowledge, this is the first reported case of a COVID-19 vaccination being temporally associated with the development of PR. Their patient's clinical presentation and histopathologic findings were consistent with PR; the temporal association with the administration of the COVID-19 vaccine suggests that their patient's vaccination triggered development of PR. While PR most commonly presents spontaneously, with no known preceding trigger, neither this patient's age, nor the time of year, was typical of pityriasis rosea, making the antecedent vaccine the most likely cause. It is possible that the state of altered immunity due to his recent vaccination may have led to an endogenous reactivation of HHV-6 or HHV-7, which served as the viral trigger for this cutaneous eruption. Alternatively, as COVID-19 infection has also been reported to trigger PR, vaccination against this viral antigen may have served as a noninfectious trigger for the classic PR skin rash.  No follow-up attempts are possible; information about batch number cannot be obtained. No further information is expected.; Sender's Comments: Based on temporal association, the reported event Pityriasis rosea is possibly related to BNT162B2. The impact of this report on the benefit-risk profile of the Pfizer product and on the conduct of the study 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.