A severe adverse event after COVID-19 vaccination: a case report of toxic epidermal necrolysis syndrome

Background: Stevens-Johnson syndrome (SJS)—a toxic epidermal necrolysis (TEN)—encompasses a spectrum of acute, delayed mucosal hypersensitivity reactions usually caused by drugs or their metabolites, and in very rare cases by infections and vaccines. Treatment of this condition is multidisciplinary and based on both wound and medical management in specialised units. Case Description: A 56-year-old woman was admitted to the Emergency Department (ED) because of fever and rapidly developing large skin lesions 5 days after receiving the fourth dose of the Pfizer-Comirnaty coronavirus disease 2019 (COVID-19) vaccine and 4 days after receiving ribociclib. A soft tissue ultrasound (ST-US) revealed hyperechogenic, thickened areas of skin without fluid accumulation or hyperechoic patches and no subcutaneous involvement. A skin biopsy confirmed the clinical suspect of SJS/TEN. After supportive and immunosuppressive therapy, a complete remission was achieved. Conclusions: A literature search in PubMed disclosed 12 previously documented cases of SJS/ TEN associated with COVID-19 vaccinations. All previous cases manifested the reaction 1–2 weeks after administration of the first or second dose of vaccine, they were treated with supportive and immunosuppressive therapy and generally had a good prognosis. The herein-described case showed common features with those that have been previously reported and peculiar ultrasonographic findings which corroborate the concept that SJS/TEN may be related to COVID-19 vaccine at least in a subset of unpredictably susceptible patients.