Case report: Acute Localized Exanthematous Pustulosis Following mRNA-1273 SARS-CoV-2 Vaccination

Peter A Young,Michael W Su,Jessica B Chan

doi:10.31579/2690-4861/180

Abstract

Acute localized exanthematous pustulosis (ALEP) is a rare subtype of acute generalized exanthematous pustulosis (AGEP) with identical histologic findings. It results from a T-cell related neutrophilic inflammatory response and is characterized by monomorphic sterile pustules confined to the face, neck, or chest. Two cases of similar facial pustular eruptions in association with the messenger RNA–1273 SARS-CoV-2 vaccine have been reported, both in males of lighter skin over 50 years old. To highlight this rare reaction and its clinical appearance in patients of pigment-rich skin, we report the case of a young adult female with ALEP following injection of the RNA–1273 SARS-CoV-2 vaccine.

Highlights

Acute generalized exanthematous pustulosis (AGEP) is a severe cutaneous reaction pattern characterized by fever, neutrophilia, and sterile pustules on an erythematous background
Acute localized exanthematous pustulosis (ALEP) is a rare subtype of AGEP with identical histologic findings, characterized by monomorphic sterile pustules confined to the face, neck, or chest
A 25-year-old African American female presented to the emergency department with a 24-hour history of a “burning rash” on her face. She had received her first dose of messenger RNA1273 SARS-CoV-2 vaccine which was followed within hours by itching and redness of her chest, that resolved spontaneously before her facial eruption

Summary

Introduction

Acute generalized exanthematous pustulosis (AGEP) is a severe cutaneous reaction pattern characterized by fever, neutrophilia, and sterile pustules on an erythematous background. A 25-year-old African American female presented to the emergency department with a 24-hour history of a “burning rash” on her face Three days before, she had received her first dose of messenger RNA (mRNA)1273 SARS-CoV-2 vaccine which was followed within hours by itching and redness of her chest, that resolved spontaneously before her facial eruption. She had received her first dose of messenger RNA (mRNA)1273 SARS-CoV-2 vaccine which was followed within hours by itching and redness of her chest, that resolved spontaneously before her facial eruption Four days before, she had finished a 10-day course of oral norethindrone for secondary amenorrhea (her only recent novel medication).

Discussion

Conclusion