Abstract

Introduction:

Granuloma annulare (GA) is a benign skin condition of unknown etiology that is self-limiting in nature. However, it is hypothesized that trauma, medications, malignancy, viral infections, different vaccines, and hypersensitivity reactions can trigger the formation of GA. Only three cases of post-SARS-CoV-2 vaccination-related granuloma annulare have been reported so far, and we report the fourth documented case of post-SARS-CoV-2 vaccination-related generalized GA.

Case Report:

An 82-year-old female presented with the chief complaint of a papule-nodular skin rash on her proximal inferior lateral left thigh and abdomen post-COVID vaccination. She received two vaccines at least and has not tested positive for COVID. On physical examination, apart from the rash on the leg, there were subcutaneous nodules on the exterior anterior surface of bilateral forearms that are mobile, relatively firm, and feel like granulomas.

Histological examination revealed a diffuse infiltrate of dermal aggregates of loosely arranged histocytes with background foci of apparent necrobiosis and poorly formed granulomas that were consistent with granuloma annulare.

Immunohistochemistry (IHC) for GMS, AFB, PAS, and CD68 was performed. CD68 highlights the histiocytes; PAS and GMS were negative for microorganisms. Taken together, the histological, IHC, and patient's clinical histories of COVID-19 vaccination confirm the diagnosis of granuloma annulare post-SARS-CoV-2 vaccination.

Conclusion:

We are sharing this case to provide awareness to our colleagues' pathologists and clinicians about the potential, though rare, occurrence of granuloma annulare (GA) as a possible adverse event after SARS-CoV-2 vaccination.