Age: 39.0
Sex: F
Vaccine: COVID19
Symptoms: Angiotensin converting enzyme, Antinuclear antibody, Biopsy, Blood thyroid stimulating hormone, Chest X-ray
Clinical narrative: sarcoid-like cutaneous reaction to tattoo pigment; This literature-non-study case was reported in a literature article and describes the occurrence of SARCOID-LIKE REACTION (sarcoid-like cutaneous reaction to tattoo pigment) in a 39-year-old female patient who received SPIKEVAX NOS (SPIKEVAX NOS) for COVID-19 prophylaxis.   LITERATURE REFERENCE.    Concurrent medical conditions included Psoriasis (mild psoriasis on the elbows) and Vitamin D deficiency.   On an unknown date, the patient received second dose of SPIKEVAX NOS (SPIKEVAX NOS) (unknown route) 1 dosage form. On an unknown date, received first dose of SPIKEVAX NOS (SPIKEVAX NOS) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced SARCOID-LIKE REACTION (sarcoid-like cutaneous reaction to tattoo pigment) (seriousness criterion medically significant). The patient was treated with HYDROCORTISONE (topical) at a dose of 2.5%; CLOBETASOL PROPIONATE (CLOBETASOL 0.05%) (topical) at an unspecified dose and frequency and PREDNISONE (oral use) at a dose of 1 milligram/kilogram, taper. At the time of the report, SARCOID-LIKE REACTION (sarcoid-like cutaneous reaction to tattoo pigment) was resolving.      DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Angiotensin converting enzyme: within normal limits. On an unknown date, Antinuclear antibody: Antinuclear antibody was 1:80. On an unknown date, Biopsy: punch biopsy of the tattoo on the upper portion of her left arm revealed an unremarkable epidermis, with dermal nodular aggregates of giant histiocytes with a mild associated lymphocytic infiltrate without caseation. Grocott methenamine silver, periodic acidSchiff, and Fite's acid-fast stains did not reveal infectious organisms. These findings were consistent with sarcoid-like cutaneous reaction to tattoo pigment.. On an unknown date, Blood thyroid stimulating hormone: within normal limits. On an unknown date, Chest X-ray: unremarkable. On an unknown date, Full blood count: within normal limits. On an unknown date, HIV test: Negative. On an unknown date, Metabolic function test: within normal limits. On an unknown date, Mycobacterium tuberculosis complex test: (Negative) QuantiFERON gold. On an unknown date, Physical examination: Sarcoidal firm papules present within the multicolored tattoo on the upper portion of the left arm and eyebrows with firm papules within red/dark brown tattoo pigment. The tattoo on the lower portion of her back did not have any nodules.. On an unknown date, Treponema test: Negative. On an unknown date, Urine analysis: Urinalysis was negative for proteinuria.. On an unknown date, Vitamin D: Vitamin D serum level was slightly low.     For SPIKEVAX NOS (SPIKEVAX NOS) (Unknown), the reporter considered SARCOID-LIKE REACTION (sarcoid-like cutaneous reaction to tattoo pigment) to be related.    Concomitant medications were not reported.  Patient presented to the dermatology clinic for a pruritic rash within 3 of her 4 tattoos. Affected areas included a multicolored ink tattoo (black, green, red, and blue) on the upper portion of her left arm present for 6 years and dark brown/red-inked tattooed eyebrows present for 8 years. She had an additional black-inked tattoo on the lower portion of her back (present for 14 years) that did not develop a rash.   Patient noticed rashes on her eyebrows and the upper portion of her left arm appeared on her tattoos approximately 1 month after receiving a second dose of the Moderna COVID-19 vaccine. Patient had received her first dose of the same vaccine brand 28 days beforehand.  The patient was initially treated with topical hydrocortisone cream 2.5% for the eyebrows and topical clobetasol cream 0.05% with minimal improvement. Therefore, an oral prednisone taper of approximately 1 mg/kg for 3 weeks was initiated, leading to significant improvement in pruritus and flattening of both the eyebrow and arm tattoo nodules.     Company Comment: This is a Literature-Non-Study case concerning a 39-year-old, female patient with medical history of psoriasis, who experienced the unexpected serious (medically significant) event of Sarcoid-like reaction. The patient noticed rashes on her eyebrows and the upper portion of her left arm appeared on her tattoos approximately 1 month after receiving a second dose of SPIKEVAX NOS vaccine. A punch biopsy performed on the tattoo located on the upper part of the patient's left arm showed a normal epidermis and dermal nodular clusters of large histiocytes accompanied by a slight lymphocytic infiltrate, with no signs of caseation. Other investigations performed did not revealed significant information. The patient initially received topical treatments, including 2.5% hydrocortisone cream for the eyebrows and 0.05% clobetasol cream, which led to minimal improvement. Consequently, a 3-week oral prednisone taper at 1 mg/kg was started, resulting in a marked reduction in pruritus and a flattening of the nodules on the eyebrow and arm tattoo. Patient underlying condition of psoriasis is a contributor risk factor for the event. The benefit-risk relationship of SPIKEVAX NOS Vaccine is not affected by this report.