Sex: M
Vaccine: COVID19
Symptoms: Biopsy skin, Complement factor C3, Eosinophil count, Eosinophil count increased, Immunology test
Clinical narrative: bullous pemphigoid; erythrocyte sedimentation rate 40 mm/hour; absolute eosinophils count 0.6 k/cumm; This is a literature report for the following literature source(s).  A 70-year-old male patient received BNT162b2 (BNT162B2), as dose 2, single (Batch/Lot number: unknown) for covid-19 immunisation. The patient's relevant medical history included: "Parkinson's disease" (unspecified if ongoing); "coronary artery disease" (unspecified if ongoing); "stage III chronic kidney disease" (unspecified if ongoing); "obstructive sleep apnea" (unspecified if ongoing); "chronic anemia" (unspecified if ongoing); "alcohol abuse disorder" (unspecified if ongoing); "renal cell carcinoma" (unspecified if ongoing), notes: status post right radical nephrectomy; "squamous cell caricinoma of the lung" (unspecified if ongoing), notes: in remission after chemoradiation. Concomitant medication(s) included: PIMAVANSERIN taken for parkinson's disease. Vaccination history included: Covid-19 vaccine (Dose 1; manufacturer unknown), for COVID-19 immunisation. The following information was reported: PEMPHIGOID (hospitalization, medically significant), outcome "recovering", described as "bullous pemphigoid"; RED BLOOD CELL SEDIMENTATION RATE INCREASED (non-serious), outcome "unknown", described as "erythrocyte sedimentation rate 40 mm/hour"; EOSINOPHIL COUNT INCREASED (non-serious), outcome "unknown", described as "absolute eosinophils count 0.6 k/cumm". The event "bullous pemphigoid" required emergency room visit. The patient underwent the following laboratory tests and procedures: Biopsy skin: bullous pemphigoid, notes: sub-epidermal bulla with eosinophils; Complement factor C3: 0.8 g/dl, notes: Normal; Eosinophil count: 0.6 k/cumm, notes: mildly elevated; Immunology test: weak linear deposition of immunoglobulin G (IgG), notes: and strong linear C3 deposition at the dermal-epidermal junction; Physical exam: Remarkable for tense bullae with negative Nikolsky; Red blood cell sedimentation rate: 40 mm/hour, notes: elevated. Therapeutic measures were taken as a result of pemphigoid.  Clinical course: The patient presented with the chief complaint of blistering skin rash. The patient received his second dose of Pfizer COVID-19 vaccine two days before developing a painful pruritic maculopapular rash that started on his hands and extended proximally to his trunk. He was seen in the emergency department (ED) and discharged home on permethrin for presumed scabies. Due to a lack of improvement, he came back to the ED after one week. At this time, the rash had evolved into tense bullae and involved most of his body without any mucosal involvement. This development warranted hospital admission. He denied fever, chills, dyspnea, cough, nausea, or vomiting. No sick contacts were reported. The etiology of the rash was initially thought to be drug-related since he was recently started on a new medication, pimavanserin, for Parkinson's disease treatment. Despite discontinuing the medication for more than one week, his rash continued to progress, warranting further investigation. The patient did not receive any recent chemoradiation or immunotherapy. His last radiation therapy was approximately two years ago. Physical exam was remarkable for tense bullae with negative Nikolsky sign. Laboratory work was remarkable for elevated erythrocyte sedimentation rate at 40 mm/hour, mildly elevated absolute eosinophils count at 0.6 k/cumm, and normal complement 3 (C3) level at 0.8 g/dl. Punch biopsy showed a sub-epidermal bulla with eosinophils. Direct immunofluorescence showed weak linear deposition of immunoglobulin G (IgG) and strong linear C3 deposition at the dermal-epidermal junction. The combination of morphological pattern, direct immunofluorescence, and expert opinion from the dermatology team lead to a diagnosis of bullous pemphigoid. After the initiation of topical and systemic steroids (prednisone and clobetasol), the lesions improved significantly. His hospital course remained uneventful and he was discharged to a rehabilitation facility. He was discharged on prednisone 60 mg daily. The patient was recommended to continue prednisone 60 mg for a total of one week, with full skin examinations every day to ensure no new blisters. After one week, prednisone was decreased to 40mg daily for one week, then 30mg daily for one week, then 20mg daily, then 10mg daily until his follow-up appointment with dermatology. He was also discharged on topical clobetasol propionate 0.05% ointment for a total of two weeks.; Sender's Comments: Based on the available information in the case, an association between the reported events PEMPHIGOID and The suspected drug cannot be ruled out.  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.