Abstract

The introduction of SARS-CoV-2 vaccines such as BNT162b2 (Pfizer-BioNTech), mRNA-1273 (Moderna) and Ad26.COV2.S (Janssen), has prevented thousands of deaths from COVID-19 in the United States. With a vast number of people receiving these vaccines, some rare adverse effects of the vaccines are increasingly being reported. While the spectrum of cutaneous adverse effects is not entirely clear, some patients have reportedly developed exacerbations of previously known autoimmune bullous diseases. More recently, the development of pemphigus vulgaris (PV) in immunocompetent patients, with no prior history of autoimmune disease, is emerging as a very rare adverse effect of the SARS-CoV-2 vaccines. Four such cases of PV after SARS-CoV-2 vaccination have been reported till date. We hereby report the fifth case. A middle age female patient with no previous history of autoimmune disease presented with multiple superficial ulcers throughout the oral cavity. She had developed several oral symptoms including throat pain, burning sensation etc. in succession in the months preceding presentation. These symptoms had started after she received the second dose of mRNA-1273 vaccine. Her serological workup for relevant autoimmune connective tissue diseases was negative. Due to a suspicion of vesicullobullous disease, a maxillary gingival biopsy was performed. The histologic as well as direct immunofluorescence findings were consistent with a diagnosis of pemphigus vulgaris. The patient was treated with oral methylprednisone and demonstrated substantial improvement in her clinical condition. This case report intends to increase the awareness in the healthcare providers regarding development of PV, as a very rare and emerging adverse effect, following SARS-CoV-2 vaccination.

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