key: cord-1042075-tzn9rv3x
authors: Lefeuvre, M.; Kerneuzet, I.; Darrieux, L.; Safa, G.
title: Multisystem inflammatory syndrome with erythema multiforme-like rash in an adult after mRNA COVID-19 vaccination
date: 2022-02-11
journal: Ann Dermatol Venereol
DOI: 10.1016/j.annder.2022.02.001
sha: 6e7c0342cc78d7ab2fa66d612c7ffec00e0aad97
doc_id: 1042075
cord_uid: tzn9rv3x

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vaccination are generally minor and self-limiting, and they should not discourage vaccination [1] . However, in a registry-based study of collected cases of cutaneous side effects of messenger RNA (mRNA) COVID-19 vaccines (Pfizer/BioNTech and Moderna), vaccine reactions, which were similar to SARS-CoV-2 infection reactions, were observed. The reactions to infection with SARS-CoV-2 may suggest a host-immune response to the virus that is also seen after vaccination [2] . Herein we describe a case of multisystem inflammatory syndrome with erythema multiforme (EM)-like rash in an adult following Pfizer/BioNTech COVID-19 vaccination. The incidence of specific diagnostic criteria is roughly similar in adults and in children.

However, cheilitis, meningitis and thrombocytosis are observed in a larger percentage of children, while arthralgia, adenopathy and liver function abnormalities are more common in adults [3] . Atypical or incomplete forms of KD are well recognized and may be very challenging to diagnose [4] . Incomplete KD is diagnosed in cases involving fever with 2 or 3 of the clinical criteria. Diffuse erythematous maculopapular eruption is the most common form of polymorphous rash. However, KD may uncommonly present with various cutaneous presentations, such as urticarial exanthem, scarlatiniform rash, erythroderma, EM-like rash, or micropustular eruption [5] [6] [7] . In our patient, EM was also considered in the differential infection [14, 15] . Of note, both MIS-C and MIS-A share certain clinical and laboratory findings with KD. Because of overlapping clinical manifestations and the lack of a specific diagnostic test for either MIS or KD, distinguishing the two conditions in an individual patient can be challenging [16] . Although most experts favor the assumption that MIS is a novel entity Page 5 of 15 J o u r n a l P r e -p r o o f 5 with respect to KD, some authors lean towards the hypothesis that MIS is on the KD spectrum, with some of the differences in phenotypic severity being due to the magnitude or kinetics of the immune response [17] . Moreover, suspected cases of MIS have recently been reported following COVID-19 vaccination (MIS-V) [18, 19] . To date, the exact incidence, prevalence and pathophysiology of MIS-V remain unclear. Theories of dysregulation of the immune system, cytokine storm, and/or hyper-reactivity of the immune system due to vaccination have been suggested [18] . However, subclinical COVID-19 infection around the time of vaccination leading to MIS, which is misattributed to vaccination, is also a possible etiology [20] .

Although it is impossible to establish a causative effect based on an individual case report, this case should be reported. In the time of the COVID-19 pandemic with a mass COVID-19 vaccination campaign, this report could alert health professionals to the possibility that the onset of MIS may be a rare and severe side effect of mRNA COVID-19 vaccination, especially given the potential complications and therapeutic implications.

The authors declare that they have no conflicts of interest. 

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Adult Kawasaki disease: report of two cases and literature review

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Multisystem inflammatory syndrome in an adult following SARS-CoV-2 vaccine (MIS-V)

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