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Adverse reactions, especially cutaneous reactions, to coronavirus disease COVID vaccination are generally minor and self-limiting, and they should not discourage vaccination [1]. The reactions to infection with SARS-CoV-2 may suggest a host-immune response to the virus that is also seen after vaccination [2]. A year-old man was admitted to our dermatology department on June 11, , with a 5-day history of fever and acute onset of generalized polymorphous rash.
The patient had been taking verapamil since for paroxysmal supraventricular tachycardia. He had not begun any new medications, and there was no change in his current medications. He denied any history of recent illness before hospital admission and had no known COVID exposure. He had generalized erythematous targetoid macules and papules with tiny pustules on the trunk and swollen lips with erosions on the lips and oral mucosa Fig.
There was no genital involvement. He had no cervical, axillar, or inguinal lymphadenopathy and no conjunctival injection. The results from viral testing were negative for human immunodeficiency virus, Epstein-Barr virus, cytomegalovirus, hepatitis B virus, hepatitis C virus, and parvovirus B Blood and urinary cultures remained negative. Skin biopsies of the trunk lesions showed spongiotic dermatitis with neutrophilic epidermal pustules, superficial dermal edema, and mild perivascular infiltrate of lymphocytes with neutrophils and scattered eosinophils.
Intraepidermal dyskeratotic cells were not observed. Clinical features: a: erythematous targetoid macules and papules with tiny pustules on the trunk; b: close-up view showing micropustular lesions on the trunk; c: erythema, swelling and erosions of lips. The history of no current use of medication in the patient along with the clinical, laboratory and histopathological findings made the diagnoses of acute generalized exanthematous pustulosis, drug reaction with eosinophilia and systemic symptoms or EM major unlikely.
