Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: Anti-cyclic citrullinated peptide antibody, Biopsy skin, C-reactive protein, Dermatitis psoriasiform, Full blood count
Clinical narrative: later developed swelling of the digits with morning stiffness, a delayed serum sicknesslike reaction secondary to COVID-19 vaccination was possible; later developed swelling of the digits with morning stiffness, a delayed serum sicknesslike reaction secondary to COVID-19 vaccination was possible; swollen, painful, discolored digits; Psoriasiform dermatitis; This literature-non-study case was reported in a literature article and describes the occurrence of DERMATITIS PSORIASIFORM (Psoriasiform dermatitis) in a 65-year-old female patient who received mRNA-1273 (Spikevax) for COVID-19 prophylaxis. The occurrence of additional non-serious events is detailed below.   LITERATURE REFERENCE:     Concurrent medical conditions included Sjoegren's syndrome.    On an unknown date, the patient received first dose of mRNA-1273 (Spikevax) (unknown route) 1 dosage form. On an unknown date, the patient experienced DERMATITIS PSORIASIFORM (Psoriasiform dermatitis) (seriousness criterion medically significant). an unknown date, the patient experienced MUSCULOSKELETAL STIFFNESS (later developed swelling of the digits with morning stiffness, a delayed serum sicknesslike reaction secondary to COVID-19 vaccination was possible), SERUM SICKNESS-LIKE REACTION (later developed swelling of the digits with morning stiffness, a delayed serum sicknesslike reaction secondary to COVID-19 vaccination was possible) and PERIPHERAL SWELLING (swollen, painful, discolored digits). At the time of the report, DERMATITIS PSORIASIFORM (Psoriasiform dermatitis) had resolved and MUSCULOSKELETAL STIFFNESS (later developed swelling of the digits with morning stiffness, a delayed serum sicknesslike reaction secondary to COVID-19 vaccination was possible), SERUM SICKNESS-LIKE REACTION (later developed swelling of the digits with morning stiffness, a delayed serum sicknesslike reaction secondary to COVID-19 vaccination was possible) and PERIPHERAL SWELLING (swollen, painful, discolored digits) outcome was unknown.      DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Anti-cyclic citrullinated peptide antibody: within reference range. On an unknown date, Biopsy skin: showed psoriasiform dermatitis with confluent parakeratosis and scattered necrotic keratinocytes. There was superficial perivascular inflammation with rare eosinophils. On an unknown date, C-reactive protein: within reference range. On an unknown date, Full blood count: within reference range. On an unknown date, Laboratory test: (Positive) set as abnormal. On an unknown date, Metabolic function test: within reference range.. On an unknown date, Physical examination: revealed an erythematous scaly rash with plaques and papules on the neck and back (pink-erythematous, scaly plaques were present on the posterior trunk). Also, scattered scaly papules with mild macular erythema were present on the left upper chest and clavicular region, with pink to deep rederythematous papules coalescing linearly on the neck and left shoulder 2 days after vaccination. On an unknown date, Red blood cell sedimentation rate: within reference range.. On an unknown date, Rheumatoid factor: within reference range.     mRNA-1273 (Spikevax) (Unknown) was withdrawn on an unknown date.   For mRNA-1273 (Spikevax) (Unknown), the reporter considered DERMATITIS PSORIASIFORM (Psoriasiform dermatitis), MUSCULOSKELETAL STIFFNESS (later developed swelling of the digits with morning stiffness, a delayed serum sicknesslike reaction secondary to COVID-19 vaccination was possible) and SERUM SICKNESS-LIKE REACTION (later developed swelling of the digits with morning stiffness, a delayed serum sicknesslike reaction secondary to COVID-19 vaccination was possible) to be related and PERIPHERAL SWELLING (swollen, painful, discolored digits) to be possibly related.    No concomitant medications were reported.  The patient treated with a systemic corticosteroid.  It was reported that the patient was presented to her primary care physician because of the severity of psoriasiform dermatitis that developed 5 days after receiving first dose of the Moderna COVID-19 mRNA vaccine. The patient's medication history was negative, and her family history was negative for autoimmune disease. The patient presented again to primary care 2 days later with swollen, painful, discolored digits i.e., pink hands with edematous phalanges and a stiff, sore neck.  The rash resolved in 1 week and did not receive the second dose due to the rash.  Cutaneous manifestations, present in 16% to 50% of patients with Sjogren syndrome, are considered one of the most common extraglandular presentations of the syndrome and classified as nonvascular (eg, xerosis, angular cheilitis, eyelid dermatitis, annular erythema) and vascular (eg, Raynaud phenomenon, vasculitis). The patient involved did not have any of those findings and not taken any medications before the rash appeared, thereby ruled out a drug reaction.  The differential diagnosis for this patient included posturinary tract infection immune-reactive arthritis and rash, which is not typical with Escherichia coli infection but is described with infection with Chlamydia species and Salmonella species; Systemic lupus erythematosuslike rashes but histology and topography are different , and a delayed serum sicknesslike reaction secondary to COVID-19 vaccination, suggested by the rash, swelling of the digits with morning stiffness. The author stated that the findings in the patient suggested a direct role for the vaccine in skin manifestations, rather than a reactivation or development of new systemic autoimmune processes.  Company Comment: This is a literature non-study case concerning a 65 year-old female patient with a history of Sjoegren's syndrome, and no family history for autoimmune diseases, who experienced the serious (due to medically significant) unexpected event of Dermatitis psoriasiform, and the non-serious unexpected events of Musculoskeletal stiffness, Serum sickness-like reaction, and peripheral swelling. The event Dermatitis psoriasiform occurred approximately 5 days after the first dose of mRNA-1273 administration and the events Musculoskeletal stiffness, Serum sickness-like reaction, and Peripheral swelling occurred 7 days after the first dose of mRNA-1273. The patient presented to her primary care physician with erythematous scaly rash with plaques and papules on the neck and back that developed 5 days after receiving first dose of the vaccine and 2 days later she presented with swollen, painful, discolored digits and a stiff, sore neck. Work out was positive for antiSjogren syndromerelated antigens A and B; blood counts, Red blood cell sedimentation rate, C-reactive protein, metabolic function test were normal and Rheumatoid factor anti-cyclic citrullinated peptide antibody, were negative. The biopsy of the skin showed psoriasiform dermatitis. The treatment included systemic steroids. The outcome of the event was reported as resolved in 1 week. The patient did not receive the second dose due to the rash. As per the author differential diagnosis for this patient included posturinary tract infection immune-reactive arthritis and rash (no information was provided about urinary tract infection event), and a delayed serum sicknesslike reaction secondary to COVID-19 vaccination. Underlying Sjoegren's syndrome might have been a risk factor for this immune mediated skin reaction post vaccination. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.   Most recent FOLLOW-UP information incorporated above includes: On 18-Jan-2023: Follow up received by safety on 19-JAN-2023 has Email received and contains new updates. Reporter information, literature information, medical history, laboratory data and event information were updated. Sender's Comments: This is a literature non-study case concerning a 65-year-old female patient with a history of Sjoegren's syndrome, and no family history for autoimmune diseases, who experienced the serious (due to medically significant) unexpected event of Dermatitis psoriasiform, and the non-serious unexpected events of Musculoskeletal stiffness, Serum sickness-like reaction, and peripheral swelling. The event Dermatitis psoriasiform occurred approximately 5 days after the first dose of mRNA-1273 administration and the events Musculoskeletal stiffness, Serum sickness-like reaction, and Peripheral swelling occurred 7 days after the first dose of mRNA-1273. The patient presented to her primary care physician with erythematous scaly rash with plaques and papules on the neck and back that developed 5 days after receiving first dose of the vaccine and 2 days later she presented with swollen, painful, discolored digits and a stiff, sore neck. Work out was positive for antiSjogren syndromerelated antigens A and B; blood counts, Red blood cell sedimentation rate, C-reactive protein, metabolic function test were normal and Rheumatoid factor anti-cyclic citrullinated peptide antibody, were negative. The biopsy of the skin showed psoriasiform dermatitis. The treatment included systemic steroids. The outcome of the event was reported as resolved in 1 week. The patient did not receive the second dose due to the rash. As per the author differential diagnosis for this patient included posturinary tract infection immune-reactive arthritis and rash (no information was provided about urinary tract infection event), and a delayed serum sicknesslike reaction secondary to COVID-19 vaccination. Underlying Sjoegren's syndrome might have been a risk factor for this immune mediated skin reaction post vaccination. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.