key: cord-0715089-wo9wxejd
authors: Shah, Kishan M.; West, Cameron; Simpson, Jana; Rainwater, Yevgeniya B.
title: Cutaneous mucormycosis following COVID-19 Vaccination in a Bullous Pemphigoid Patient
date: 2021-06-26
journal: JAAD Case Rep
DOI: 10.1016/j.jdcr.2021.06.012
sha: b50d5edb75b6b68c79134cfb3ef42178d177cd0c
doc_id: 715089
cord_uid: wo9wxejd

nan

Mucormycosis is a severe fungal infection caused by the Mucor genus., and infections 19 often occur in immunocompromised individuals. 1 Major risk factors include: diabetes, being a 20 transplant recipient, a history of trauma or burns, prolonged corticosteroid treatment, and 21 hematologic malignancies. 2 Early identification is paramount given Mucor spp. predilection for 22 vascular invasion, paucity of effective antifungal treatments, and reported 96% mortality in 23

While cutaneous mucomycosis has been associated with adhesive tape and other adhesive 25 devices in premature infants and adults with immunodeficiency, it has never been reported at the 26 site of prior vaccination. 2-4 We report a case of cutaneous mucormycosis at the site of 27

Coronavirus-19 (COVID-19) vaccination, mRna-1723 (Moderna, Massacusetts, USA). 28

A 94-year-old male with hypertension and bullous pemphigoid presented with a new, 30 intensely pruritic papule that developed at the injection site of the first dose of mRna-1723 31 received two days prior to presentation. Following vaccination, an adhesive bandage was 32 applied and remained in place for 24 hours. Severe pruritus developed two days after inoculation 33 and vigorous scratching ensued. On exam, a five-millimeter erythematous papule was noted 34 overlying the right deltoid. The differential diagnosis included a lesion of bullous pemphigoid, 35 bullous impetigo, and allergic or irritant contact dermatitis to the adhesive. A 4 mm punch 36 biopsy was obtained. Histopathologic examination revealed suppurative and granulomatous 37 dermatitis surrounding a neutrophilic microabscess in the reticular dermis. Thick-walled, non-38 septate, bifurcated hyphae were identified within the infiltrate and inside multinucleated giant 39 cell (Figure 1, 2) . Periodic-Acid Schiff stain confirmed the presence of fungal hyphae ( Figure  40 of intravenous micafungin daily for two weeks. Tissue polymerase chain reaction was positive 42

for Rhizopus oryzae complex. The second dose of mRna-1723 was administered without 43 subsequent complications. However, the depth of the identified organism in the reticular dermis militates against 56 direct inoculation, as mRna-1723 is administered intramuscularly. Application of clobetasol 57

Zygomycetes in human disease

Epidemiology and outcome of 73 zygomycosis: a review of 929 reported cases

Healthcare-associated mucormycosis

Nosocomial outbreak of Rhizopus infections associated 77 with Elastoplast wound dressings

Hospital-acquired mucormycosis 79 (Rhizopus rhizopodiformis) of skin and subcutaneous tissue: epidemiology, mycology 80 and treatment

Occurrence as a postoperative complication associated with an elasticized adhesive 83 dressing

Absidia corymbifera infection associated with bandage contamination in a burns unit

Outbreak of cutaneous Rhizopus 91 arrhizus infection associated with karaya ostomy bags

Pruritus in elderly patients--eruptions of senescence