Abstract
Gyrate erythema (GE) is a perivascular dermatitis associated with numerous drugs, malignant tumors, and infectious agents. While GE related to COVID-19 has been reported, it has not been described in association with vaccination. We report a case of GE occurring in close temporal association with COVID-19 vaccination. An 18-year-old woman with a remote history of chronic hives and no new medications developed a pruritic rash two days after receiving the first dose of the Pfizer-BioNTech COVID-19 mRNA vaccine. The rash was composed of multiple well-circumscribed, erythematous, annular-to-targetoid edematous plaques involving the bilateral upper and lower extremities, trunk, and face. There was no conjunctival, nasal or oral mucosa or vulvar involvement. The clinician prescribed prednisone and performed a punch biopsy due to concern for erythema multiforme. Histologic sections revealed orthokeratosis overlying an unremarkable epidermis. Within the superficial dermis, there was a dense, tightly cuffed perivascular lymphocytic infiltrate. Eosinophils were not readily identified. Neutrophils were seen marginating within vessel lumens. Overall, the clinicopathologic findings were consistent with gyrate erythema. On follow-up examination, a week later, the patients rash was improved and was no longer pruritic.The mRNA Pfizer COVID-19 vaccine has been associated with various cutaneous eruptions, including local injection site reactions, hypersensitivity reactions, and morbilliform rashes. However, to the best of our knowledge, it has not been yet been associated with GE. The close temporal onset relative to vaccination, and the patients lack of new medications or illness suggest the possibility that this reaction represents COVID-19 vaccine-induced GE. This case adds to the variety of reactions seen in close temporal association and possibly induced by COVID-19 mRNA vaccines.
Financial Disclosure:
No current or relevant financial relationships exist.