Abstract

Transient acantholytic dermatosis, or Grover’s disease, is a pruritic, papulovesicular rash with predilection for the trunk. Triggers include heat, perspiration, occlusion, environmental factors, and medications. Viral illnesses and vaccinations have been reported to provoke acantholytic eruptions. We present a 79-year-old white male with three-month history of pruritic, unilateral rash two weeks after his second dose of Pfizer-BioNTech COVID-19 vaccine. Physical exam noted scattered, eroded inflammatory papules and crusted vesicles with faint erythema on the left arm at the site of vaccine and locally infiltrating onto left shoulder and chest. Punch biopsy demonstrated focal areas of epidermal acanthosis with hyperkeratosis, acantholysis, and dyskeratosis. One section included a column of parakeratosis resembling a cornoid lamellae. There was superficial perivascular lymphohistiocytic infiltrate with eosinophils. DIF was unremarkable. A diagnosis of transient acantholytic dermatosis or “Grover’s-like eruption” was made, and symptoms improved with topical steroids and oral antihistamines. There are four histologic subtypes of Grover’s: Darier-like, Pemphigus vulgaris-like, Hailey-Hailey-like, and Spongiotic. It is characteristically recalcitrant to treatment, but typically self-resolves and most effective management is avoidance of triggers. It typically presents as a symmetric eruption, thus given this atypical unilateral presentation and temporal association following the COVID-19 vaccine, we conclude this reaction was secondary to local infiltration of the vaccine. Throughout the COVID-19 pandemic, there have been a wide array of skin reactions to the COVID-19 vaccines, most notably morbilliform rashes, urticaria and pernio-like lesions, but new and unusual eruptions continue to be reported and are important to recognize. This case demonstrates an atypical presentation of Grover’s-like eruption following vaccination with the Pfizer vaccine.Financial Disclosure:
No current or relevant financial relationships exist.