Herpes Zoster Post-Vaccine Mimicking “COVID Arm” in an Old Female

Vitorino Modesto Dos Santos,Julia Campos Modesto,Taciana Arruda Modesto Sugai,Laura Campos Modesto

doi:10.7324/jhsr.2022.712

Abstract

Cutaneous adverse effects related to SARS-CoV-2 vaccines are still a challenging issue. “COVID arm” is a manifestation of delayed hypersensitivity reaction appearing after the SARS-CoV-2 vaccination as reddish, warm, pruritic, indurated, or swollen areas in the limb of the vaccine site. These skin alterations may be associated with systemic symptoms and have been observed after the first or second dose of COVID-19 vaccines. The aim is describe a 76-year-old woman who had “COVID arm simile” lesions caused by herpes virus in the left upper limb 4 weeks after the AstraZeneca vaccine first dose. The reaction, with 30 days duration, needed treatment and was considered severe. However, the patient received the second dose of the same vaccine uneventfully. Case reports of intercurrences during mass vaccinations are advantageous for health care workers and patients.

Highlights

The following described clinical and epidemiologic features of the immediate and delayed cutaneous reactions associated with coronavirus disease 2019 (COVID-19) vaccination and “COVID arm” aim to enhance the interest in dermatological manifestations of this challenging pandemic context
Manifestations of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) or COVID-19 are associated with cytokine storm and systemic inflammatory response, and the mass vaccination constitutes the paramount measure of the public health system.[1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21]
Moderna mRNA-1273 and Pfizer-BioNTech SARS-CoV-2 vaccines use lipid nanoparticle encapsulated mRNA to provide immunity by encoding for the spike protein necessary for viral entry, while the AstraZeneca and the Janssen Johnson and Johnson (J and J) vaccines use an adenovirus as a viral vector to provide the immunity.[13,21]

Summary

Introduction

The following described clinical and epidemiologic features of the immediate and delayed cutaneous reactions associated with coronavirus disease 2019 (COVID-19) vaccination and “COVID arm” aim to enhance the interest in dermatological manifestations of this challenging pandemic context. “COVID arm” is a novel entity associated with this infection as well as with vaccines, and manifestations can be mimicked by episode of HZ.[3,4,5,6,7,8,9,10,12,13,17,18,19] Skin changes have been described 4–11 days after the first dose of mRNA-1273 vaccines and are considered delayed reactions which appeared near the injection site.[4] Some patients had similar reactions after the second dose, with duration of 2–11 days. Classical HZ skin rash and post-herpetic neuralgia (PHN) have increased along with COVID-19 pandemic and may develop following an adenovirusvectored vaccination.[3,5,8,18] Both immunocompromised. The “COVID arm” is here emphasized to enhance the interest in this very challenging entity, in addition to an overview about the HZ reactivation after vaccination against COVID-19

Case Report

Discussion

Findings

Conclusion