Abstract
Background: Pernio-like skin changes have been described in association with SARS-Cov-2 infection. Emerging literature also points to such changes being linked to COVID-19 vaccination. Case: A 66-year-old female with no significant dermatologic history presented in the spring with a 1-month history of moderately pruritic & mildly tender rash, initially on the fingers, but spread to the hands, extremities, & toes. She denied muscle/joint pain, change in personal care products or medications, & similar rash in family members. Topical hydrocortisone & triple antibiotic ointment were ineffective. Physical exam revealed erythematous, scaly, eroded, & tender papules on fingers & tips of both great toes, along with tender erythematous patches on arms & lower legs. The clinical impression was Sweet syndrome or pernio. Shave biopsy from the right index finger showed compact hyper-orthokeratosis with early epidermal degeneration & pallor centrally. The dermis had congested blood vessels, some containing fibrin, along with papillary dermal edema, red blood cell extravasation, & a perivascular lymphocytic infiltrate. The microscopic differential included pernio, chilblains lupus, & vasculopathy. A review of the patients charts revealed administration of the 2nd dose of Moderna mRNA-1273 COVID-19 vaccine less than a week before onset. One week later, the patient reported clearing. Conclusion: Although there is no proven causal relationship, the temporal association suggested the pernio-like features could be in response to the vaccine, as has been recently reported. Previous cases described variable timing of onset, the earliest being 24h post-vaccine. Immunostaining for SARS-Cov-2, which had mixed findings in previous cases, was not performed in our patient. Like COIVD-19 infection, the vaccine may elicit a similar immune response as the virus itself to cause these skin changes. This can occur after the 1st or 2nd dose & are almost always mild & self-limiting.
Financial Disclosure:
No current or relevant financial relationships exist.
