Abstract:

A 37-year-old-female with no significant past medical history presented to the dermatology clinic with two weeks of a tender cutaneous eruption on the bilateral cheeks. She had noticed a small pimple on her left cheek after receiving the first dose of a non-mRNA COVID-19 vaccination earlier in the day. Over the next several days, the lesion enlarged, and became intensely red. She visited a different clinic where she received intra-lesional triamcinolone and was prescribed triamcinolone 0.1% cream along with doxycycline. Despite these medications, the eruption continued enlarging and spread to the right cheek. At this point, the patient presented for a second opinion. She denied recent illnesses including prior COVID-19 infection as well as new exposures other than the COVID-19 vaccination. Her allergies included a rash with sulfonamides. Her family history was notable for Sjogrens syndrome in her mother. On review of systems, the patient denied fevers, chills, fatigue, weight changes, and arthralgia. On examination of the left cheek, there was a large, red, well-demarcated and indurated plaque with a slightly darker border and fine scale present inside the advancing edge. On the right cheek, there was a similar, smaller plaque. A 3-millimeter punch biopsy was obtained from the right cheek. Histopathologic examination revealed a dense, diffuse neutrophilic infiltrate in the dermis. The eruption was diagnosed as a Sweet-like presentation. The patient was started on 60 milligrams of prednisone daily and demonstrated significant clinical improvement after 4 days. Prednisone was gradually tapered, and the patient has not experienced recurrences.

Financial Disclosure:
No current or relevant financial relationships exist.

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Lavanya Mittal, MD