key: cord-1004617-kb38cg82
authors: Cinotti, E.; Perrot, J.‐L.; Bruzziches, F.; Tognetti, L.; Batsikosta, A.; Sorrentino, E.; Marzano, A.V.; Rubegni, P.
title: Eosinophilic dermatosis after AstraZeneca COVID‐19 vaccination
date: 2021-11-20
journal: J Eur Acad Dermatol Venereol
DOI: 10.1111/jdv.17806
sha: 532069a45d4b1c5fb83cfbc77e23b55b30d89faf
doc_id: 1004617
cord_uid: kb38cg82

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. Local site reactions, urticaria, and morbilliform eruptions have been recently reported as possible cutaneous adverse reactions after Moderna and Pfizer COVID-19 vaccination1 . We would like to highlight that, in addition to the described skin manifestations related to COVID19 vaccines, AstraZeneca COVID-19 vaccination could trigger a unique skin rash.

tapered in the following 3 weeks, with complete resolution of the skin lesions.

During the hospitalization, we observed increased blood leukocyte and eosinophil counts, and C reactive protein up to a peak of 14.13 9 10 3 /µl, 4.76 10 3 /µl and 11 mg/dl, respectively. These blood tests reverted to normal after 3 days. Fever (38.5°C) was observed the day before the eosinophilia peak. Skin histology revealed spongiosis, intraepidermal vesicles and a superficial and deep dermal interstitial and perivascular CD4 + and CD8 + T lymphocyte and histiocyte infiltrate with numerous eosinophils consistent with an initial phase of eosinophilic cellulitis (Wells syndrome). Direct immunofluorescence was negative. We could not find any cause for the skin rash and acute eosinophilia other than the vaccination. The patient had been receiving lercanidipine chlorhydrate for arterial hypertension for many years and it was not discontinued. Chest radiography and abdomen ultrasound were negative. Viral serology did not show any reactivation of previous Herpes Simplex 1 and 2 virus and Varicella-Zoster virus infections, and HIV test was negative. Tzanck smear from a fresh vesicle and reflectance confocal microscopy examination of the affected skin did not show any sign of herpetic infection. Parasitological stool examination was also negative. Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome diagnostic criteria were not fulfilled and cutaneous parasitoses were excluded due to negative skin scrapings and dermoscopy examinations.

Interestingly, the skin lesions of our patient had similarities with the COVID-19-related papulovesicular varicella-like exanthema. 2 Eosinophils were reported in some of the few available histological examinations of COVID-19-associated skin manifestations 3 and blood eosinophilia is possibly associated with urticarial manifestations of COVID-19. Histological features of our case were consistent with those of eosinophilic cellulitis, an eosinophilic dermatitis that may show urticarial and vesicular features and has been reported as a rare adverse event following vaccines. 4, 5 We suggest including eosinophilic cellulitis among the huge spectrum of skin reactions to COVID-19 vaccines.

With large-scale vaccination programmes, even rare adverse effects of vaccines may be encountered more often. Thus, it is paramount that dermatologists worldwide are acquainted with the possible skin reaction patterns to the coming vaccines.

The patient in this manuscript has given written informed consent to publication of his case details. 

Cutaneous reactions reported after moderna and pfizer COVID-19 vaccination: a registry-based study of 414 cases

Varicella-like exanthem as a specific COVID-19-associated skin manifestation: Multicenter case series of 22 patients

Histopathological study of a broad spectrum of skin dermatoses in patients affected or highly suspected of infection by COVID-19 in the northern part of Italy: analysis of the many faces of the viral-induced skin diseases in previous and new reported cases

New emerging diseases or syndromes in dermatopathology with impact on clinical management

Wells syndrome secondary to influenza vaccination: A case report and review of the literature