Age: 94.0
Sex: M
Vaccine: COVID19
Symptoms: Cutaneous mucormycosis, Histology, Physical examination, Polymerase chain reaction
Clinical narrative: Cutaneous mucormycosis; This literature-non-study case was reported in a literature article and describes the occurrence of CUTANEOUS MUCORMYCOSIS (Cutaneous mucormycosis) in a 94-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination.   The patient's past medical history included Skin punch biopsy (A 4-mm punch biopsy was obtained.). Concurrent medical conditions included Hypertension and Bullous pemphigoid. Concomitant products included CLOBETASOL PROPIONATE (CLOBETASOL 0.05%) for Bullous pemphigoid.   On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date,  after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced CUTANEOUS MUCORMYCOSIS (Cutaneous mucormycosis) (seriousness criterion medically significant). The patient was treated with MICAFUNGIN (intravenous) for Cutaneous mucormycosis, at a dose of 100 milligram once a day. At the time of the report, CUTANEOUS MUCORMYCOSIS (Cutaneous mucormycosis) outcome was unknown.      DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Histology: abnormal (abnormal) Histopathologic examination revealed suppurative and granulomatous dermatitis surrounding a neutrophilic microabscess in the reticular dermis. Thick-walled, nonseptate, bifurcated hyphae were identified within the infiltrate and inside the multinucleated giant cell. Periodic acidSchiff stain confirmed the presence of fungal hyphae and Cutaneous mucormycosis was suspected.. On an unknown date, Physical examination: abnormal (abnormal) On examination, a 5-mm erythematous papule was noted overlying the right deltoid. The differential diagnosis included a lesion of bullous pemphigoid, bullous impetigo, and allergic or irritant contact dermatitis to the adhesive.. On an unknown date, Polymerase chain reaction: positive (Positive) Tissue polymerase chain reaction was positive for Rhizopus oryzae complex..     For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter considered CUTANEOUS MUCORMYCOSIS (Cutaneous mucormycosis) to be possibly related.    Patient presented with a new, intensely pruritic papule that developed at the injection site of the first dose of mRNA-1723, received 2 days prior to the presentation. Following vaccination, an adhesive bandage was applied that remained in place for 24 hours. Severe pruritus developed 2 days after the inoculation and vigorous scratching ensued.  The second dose of mRNA-1723 was administered without subsequent complications.  Author concluded that it is plausible that mucormycosis from an adhesive dressing applied to the injection site could be the source of the infection in the patient in this case.  Alternatively, repeated excoriation at the vaccination site may have introduced the organism. Lastly, direct inoculation of the infectious agent via a contaminated syringe or vaccine is an additional consideration. However, the depth of the identified organism in the reticular dermis militates against direct inoculation, as mRNA-1723 is administered intramuscularly. Application of clobetasol 0.05% ointment for the patient's bullous pemphigoid as well as age-related immunosenescence and diminished epidermal barrier may have contributed to the development of cutaneous mucormycosis at the site of vaccination.  This literature report concerns a 94 year old male patient with relevant medical history of bullous pemphigoid who experienced a serious and unexpected event of cutaneous mucormycosis. The event occurred 2 days after receiving the first dose of mRNA-1273. Following vaccination, the patient had an adhesive bandage applied at the vaccination site for 24 hrs. At the same site, an intensely pruritic erythematous papule developed. Punch biopsy and the histopathologic examination of the lesion revealed a suppurative and granulomatous dermatitis surrounding a neutrophilic microabscess in the reticular dermis. Periodic acid Schiff stain confirmed the presence of fungal hyphae and cutaneous mucormycosis was suspected. The tissue polymerase chain reaction was positive fo   Most recent FOLLOW-UP information incorporated above includes: On 27-Oct-2021: Follow up received by safety on 27-Oct-2021 included an Email with FTA received from SARA team and does not contain any new information, changes from initial version included addition of conmed; Sender's Comments: This literature report concerns a 94 year old male patient with relevant medical history of bullous pemphigoid who experienced a serious and unexpected event of cutaneous mucormycosis. The event occurred 2 days after receiving the first dose of mRNA-1273. Following vaccination, the patient had an adhesive bandage applied at the vaccination site for 24 hrs. At the same site, an intensely pruritic erythematous papule developed. Punch biopsy and the histopathologic examination of the lesion revealed a suppurative and granulomatous dermatitis surrounding a neutrophilic microabscess in the reticular dermis. Periodic acid Schiff stain confirmed the presence of fungal hyphae and cutaneous mucormycosis was suspected. The tissue polymerase chain reaction was positive for Rhizopus oryzae complex. The patient was successfully treated with daily administration of 100 mg intravenous micafungin for 2 weeks.  The second dose of mRNA-1273 was administered without any further complications. The author suspected adhesive dressing applied at the injection site as the possible source of infection. In addition, the author also speculates, application of Clobetasol 0.05% ointment for the patient's bullous pemphigoid and the age related immunosenescence as possible contributing factors for the development of the event. The benefit-risk relationship of mRNA-1273 is not affected by this report.