Abstract
A previously healthy 70-year-old man, who was not taking any medications, presented with painful skin lesions and large joint polyarthralgia 15 days after the administration of a third dose of a SARS-CoV-2 BNT162b2 vaccine. The patient denied tobacco abuse and the use of amphetamines. On examination, the patient was noted to have painful bilateral ulcers of the fingers (Panel A), a lingual ulcer (Panel B), and a left auricle ulcer (Panel C). Laboratory data showed an erythrocyte sedimentation rate of 34 mm/h (normal range 0–15) and immunoglobulin G of 2166 mg/dL (normal range 700–1800). Also notable were a normal platelet count, absence of antinuclear antibodies, antiphospholipid antibodies, cryoglobulin and cold agglutinin, and normal urinalysis. Doppler ultrasonography of the upper limbs was normal. The diagnosis of SARS-CoV-2 vaccine-induced ulcerations was strongly suspected. Treatment with oral prednisone, acetylsalicylic acid, pentoxifylline, and aminaphtone was initiated. After 7 days of therapy, the polyarthralgia resolved, the lingual and auricular ulcers healed, and the hand ulcers improved. Although there is sparse literature on oral and cutaneous manifestations of the SARS-CoV-2 vaccine, Riad et al. 1 showed that 13% of healthcare workers who received the vaccine presented with oral findings, most commonly blisters, halitosis, and ulcers. Separately, in a systemic review on SARS-CoV-2 vaccine-related cutaneous manifestations, Avallone et al. 2 found chilblain-like/pernio in 0.88%, purpuric rash and vasculitis in 0.77%, Raynaud phenomenon in 0.02%, and acrocyanosis in 0.02% of patients. It has previously not been reported that the SARS-CoV-2 vaccine can result in multiple ulcers over different parts of the body.
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Footnotes
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
