Age: 54.0
Sex: F
Vaccine: FLUX
Symptoms: Blood immunoglobulin M normal, Complement factor C3, Full blood count normal, Histology, Immunology test
Clinical narrative: LINEAR IGA BULLOUS DERMATOSIS/ Linear IgA disease; VESICULO-BULLOUS ERUPTION; PRURITIC SKIN ERUPTION; rash began as tiny pink papules; rash began as tiny pink papules; Lesion\ continued to get new lesions; The rash began as tiny pink papules that then formed vesicles; bullae over the subject's lower extremities/ subepidermal blistering process; This case was reported in a literature article and described the occurrence of linear IgA bullous dermatosis in a 54-year-old female subject who was vaccinated with influenza virus vaccine (Influenza vaccine, manufacturer unspecified) for prophylaxis.   Concurrent medical conditions included depression, hyperlipidemia and osteoporosis.    Concurrent medications included Alendronate sodium (Alendronate), Calcium salt (Calcium), Sertraline hydrochloride (Zoloft), Vitamin D (Vit D) and Rosuvastatin calcium (Rosuvastatin).   The healthy subject presented at hospital with a 2-week history of a severe pruritic, vesiculobullous eruption on her legs, arms and lower abdomen that developed 2 days after she had received an influenza vaccination intramuscularly. The rash began as tiny pink papules that then formed vesicles. She continued to get new lesions despite taking diphenhydramine (Diphenylhydramine) and cetirizine hydrochloride (Cetirizine) as prescribed by her primary care physician.  The subject had not tried topical corticosteroids or any other treatments. She denied changes in her medications, use of herbal supplements or other over-the-counter medications.  The subject denied fever, chills, upper respiratory or gastrointestinal symptoms, or mucous membrane involvement.  The only recent change in the subject's medications was substitution of sertraline for Zoloft, which had occurred 2 months prior to the eruption. Otherwise, she had been on rosuvastatin for 5 months and her other medications for over 1 year. She discontinued rosuvastatin and switched back to Zoloft with no improvement.  The physical examination revealed symmetrically distributed discrete, pink papules, vesicles and bullae over the subject's lower extremities, hands, forearms and lower abdomen with particular concentration on the medial surfaces of her calves.  She had no conjunctival injection, involvement of mucous membranes, palms or soles.  This case was assessed as medically serious by GSK.  Microscopic examination of a biopsy from the left calf revealed a subepidermal blistering process with neutrophils.  Direct immunofluorescence revealed linear deposits of Ig A (negative IgG, IgM, C3, and fibrinogen) along the basement membrane zone. These findings in conjunction with the histology were most suggestive of linear IgA bullous dermatosis. The routine laboratory tests were normal including complete blood count and antiendomysial antibodies.  The eruption cleared after 2 courses of prednisone followed by a mid-potency topical corticosteroid and did not recur when she restarted sertraline and rosuvastatin.  The eruption lasted 6 weeks in total.  At the time of reporting the events were resolved.  The subject's medications are unlikely culprits as she had been on them for many months when the eruption began. Furthermore, the eruption resolved while she continued to take alendronate, calcium and vitamin D and did not recur when she restarted sertraline and rosuvastatin.  Thus, it seems plausible that the influenza vaccination prompted development of linear IgA bullous dermatosis in this subject. Although a rechallenge with influenza vaccination followed by recurr of linear IgA bullous dermatosis would provide stronger evidence for a causal relationship, the physician did not feel that it would be medically advisable for the subject to take this risk, and the subject has not received further influenza vaccinations.  The author considered the events were possibly related to vaccination with Influenza vaccine.   Follow-up information was received from author on 17th May 2022: Case type was updated to literature. Reporter contact details were added. This case corresponds to Table-1 reported in this literature article. To better understand the potential link between vaccinations and the development of autoimmune bullous diseases (AIBDs), a systematic review was performed.  The patient received Influenza vaccine and had linear IgA disease. Course of the diseases was reported as remission after topical/oral corticosetroids. Red rash, vesicular rash, skin lesion, blister events were added. "Overall, there was currently insufficient data to suggest that vaccinations were truly or commonly related to an increased risk of AIBDs, taking into account that the available information was generally based on anecdotal, single case reports with a low level of evidence and not being confirmed in largescale, population-based studies. Consequently, there was no need to modify the present vaccination recommendations for patients with AIBD, because the benefits of vaccines outweigh the likelihood of instigating autoimmune manifestations, even though real-world data on COVID-19 vaccines in AIBD patients are currently lacking". Additional supportive information: This case is 1 of the 10 cases reported in this literature article.; Sender's Comments:  US-GLAXOSMITHKLINE-US2022GSK081450:Same reporter