Erythema Multiforme Reactions Following Pfizer/BioNTech (Tozinameran)
Vaccination: Two Case-Reports with Positive Rechallenge and Review of
the Literature

Ons      Charfi; Ghozlane      Lakhoua; Khouloud      Berrim; Sarrah      Kastalli; Talel      Badri; Imen      Aouinti; Riadh      Daghfous; Ahmed      Zaiem; Sihem   EL   Aidli

doi:10.2174/1574886318666230725101846

Abstract

Aim: Pfizer/BioNTech (BNT162b2) is a COVID-19 vaccine with a reassuring safety profile. The main adverse reactions are mild local reactions. Cutaneous reactions are generally minor. The most common cutaneous reaction reported was a local injection-site reaction.

Case Study: Here we present 2 cases of erythema multiform (EM) following BNT162b2 vaccination with positive rechallenge. The 1^st case was about a 51-year-old woman who developed 5 days after the 1st dose of the mRNA Pfizer/BioNTech (BNT162b2) a macular, erythematous, roundshaped lesions on the hands, knees and soles. She experienced a positive rechallenge one month later.

In the 2^nd case, a 55-year-old man presented 6 days following the 2^nd shot of the mRNA Pfizer/ BioNTech (BNT162b2), targetoid eruption on the upper and lower members. The patient reported that he had the same skin lesions in ankles and soles few days following the 1^st shot of the same vaccine.

Conclusion: Few cases of EM following COVID-19 vaccination were reported in the literature and positive rechallenge in only one case. Rechallenge was not performed in most cases.

Our two cases are particular because of the positive rechallenge in both patients. This is the gold standard to confirm that the vaccine was the culprit agent in inducing EM.

Keywords: Erythema multiforme, COVID-19 vaccines, pharmacovigilance, adverse drug reactions, toxidermie, COVID-19.

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[1]
Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther  1981; 30(2): 239-45.
 [http://dx.doi.org/10.1038/clpt.1981.154] [PMID:  7249508]

[2]
Frederiksen MS, Brenøe E, Trier J. Erythema multiforme minor following vaccination with paediatric vaccines. Scand J Infect Dis  2004; 36(2): 154-5.
 [http://dx.doi.org/10.1080/00365540410019200] [PMID:  15061674]

[3]
Katoulis AC, Liakou A, Bozi E, et al. Erythema multiforme following vaccination for human papillomavirus. Dermatology  2010; 220(1): 60-2.
 [http://dx.doi.org/10.1159/000254898] [PMID:  19887766]

[4]
Bernardini ML, D’Angelo G, Oggiano N, et al. Erythema multiforme following live attenuated trivalent measles-mumps-rubella vaccine. Acta Derm Venereol  2006; 86(4): 359-60.
 [http://dx.doi.org/10.2340/00015555-0071] [PMID:  16874427]

[5]
Karatas E, Nazim A, Patel P, et al. Erythema multiforme reactions after Pfizer/BioNTech (BNT162b2) and Moderna (mRNA-1273) COVID-19 vaccination: A case series. JAAD Case Rep  2023; 32: 55-8.
 [http://dx.doi.org/10.1016/j.jdcr.2021.12.002] [PMID:  35097177]

[6]
Erythema multiforme after SARS-CoV-2 messenger RNA vaccination. QJM  2022; 115(1): 37-8.
 [http://dx.doi.org/10.1093/qjmed/hcab303] [PMID:  34865149]

[7]
Buján Bonino C, Moreiras Arias N, López-Pardo Rico M, et al. Atypical erythema multiforme related to BNT162b2 (Pfizer–BioNTech) COVID‐19 vaccine. Int J Dermatol  2021; 60(11): e466-7.
 [http://dx.doi.org/10.1111/ijd.15894] [PMID:  34473839]

[8]
McMahon DE, Amerson E, Rosenbach M, et al. Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: A registry-based study of 414 cases. J Am Acad Dermatol  2021; 85(1): 46-55.
 [http://dx.doi.org/10.1016/j.jaad.2021.03.092] [PMID:  33838206]

[9]
Petruzzi M, Galleggiante S, Messina S, Della Vella F. Oral erythema multiforme after Pfizer-BioNTech COVID-19 vaccination: A report of four cases. BMC Oral Health  2022; 22(1): 90.
 [http://dx.doi.org/10.1186/s12903-022-02124-2] [PMID:  35331228]

[10]
Lavery MJ, Nawimana S, Parslew R, Stewart L. A flare of pre‐existing erythema multiforme following BNT162b2 (Pfizer–BioNTech) COVID‐19 vaccine. Clin Exp Dermatol  2021; 46(7): 1325-7.
 [http://dx.doi.org/10.1111/ced.14714] [PMID:  33914926]

[11]
Katayama S, Ota M. Erythema Multiforme after BNT162b2 Vaccination. Intern Med  2022; 61(12): 1929.
 [http://dx.doi.org/10.2169/internalmedicine.9544-22] [PMID:  35431308]

[12]
Wunderlich K, Dirschka T. Erythema multiforme following COVID-19 vaccination (BNT162b2). Hautarzt  2022; 73(1): 68-70.
 [http://dx.doi.org/10.1007/s00105-021-04911-4] [PMID:  34676438]

[13]
Borg L, Mercieca L, Mintoff D, et al. Pfizer‐BioNTech SARS‐CoV‐2 mRNA vaccine‐associated erythema multiforme. J Eur Acad Dermatol Venereol  2022; 36(1): e22-4.
 [http://dx.doi.org/10.1111/jdv.17682] [PMID:  34547125]

[14]
Kim MJ, Kim JW, Kim MS, Choi SY, Na JI. Generalized erythema multiforme‐like skin rash following the first dose of COVID‐19 vaccine (Pfizer‐BioNTech). J Eur Acad Dermatol Venereol  2022; 36(2): e98-e100.
 [http://dx.doi.org/10.1111/jdv.17757] [PMID:  34661942]

[15]
Scharf C, Di Brizzi EV, Pellerone S, Liguori M, Giorgio CMR, Argenziano G. Nevocentric erythema multiforme after SARS‐COV‐2 vaccine. J Eur Acad Dermatol Venereol  2022; 36(1): e30-2.
 [http://dx.doi.org/10.1111/jdv.17688] [PMID:  34547145]

[16]
Zhang L, Wang W, Li C, Chen T. Erythema multiforme after SARS‐CoV‐2 vaccine. J Eur Acad Dermatol Venereol  2022; 36(1): e32-3.
 [http://dx.doi.org/10.1111/jdv.17689] [PMID:  34547118]

[17]
de las Vecillas L, López J, Morchón E, Rodriguez F, Drake M, Martino M. Viral-like reaction or hypersensitivity? erythema multiforme minor reaction and moderate eosinophilia after the Pfizer-BioNTech BNT162b2 (mRNA-Based) SARS-CoV-2 vaccine. J Investig Allergol Clin Immunol  2022; 32(1): 77-8.
 [http://dx.doi.org/10.18176/jiaci.0757] [PMID:  34588156]

[18]
Iwasawa O, Kamiya K, Komine M, Ohtsuki M. Case of atypical erythema multiforme following coronavirus disease 2019 vaccination. J Dermatol  2022; 49(3): e113-4.
 [http://dx.doi.org/10.1111/1346-8138.16255] [PMID:  34821413]

[19]
Saibene AM, Alliata A, Cozzi AT, et al. Erythema multiforme major following SARS‐CoV‐2 vaccine. Clin Case Rep  2021; 9(10): e04947.
 [http://dx.doi.org/10.1002/ccr3.4947] [PMID:  34667612]

[20]
Lopes NT, Pinilla CEO, Gerbase AC. Erythema multiforme after CoronaVac vaccination. J Eur Acad Dermatol Venereol  2021; 35(11): e717-9.
 [http://dx.doi.org/10.1111/jdv.17495] [PMID:  34236724]

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DOI https://dx.doi.org/10.2174/1574886318666230725101846	Print ISSN 1574-8863
Publisher Name Bentham Science Publisher	Online ISSN 2212-3911

Current Drug Safety

Erythema Multiforme Reactions Following Pfizer/BioNTech (Tozinameran) Vaccination: Two Case-Reports with Positive Rechallenge and Review of the Literature

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