Vol 10, No 3 (2024)
Case report
Published online: 2024-08-13

open access

Page views 335
Article views/downloads 211
Get Citation

Connect on Social Media

Connect on Social Media

Pemphigus foliaceous following vaccinations

Damian Kadylak12, Julia Sternicka3, Małgorzata Sokołowska-Wojdyło12, Wioletta Barańska-Rybak12, Roman J. Nowicki12
Forum Dermatologicum 2024;10(3):89-92.

Abstract

Pemphigus is a rare autoimmune bullous disease, with pemphigus vulgaris (PV) and pemphigus foliaceous (PF) being its most common forms. This report presents a case of PF triggered by vaccinations. A previously healthy 38-year-old Caucasian man developed skin lesions six months after receiving vaccinations for hepatitis A, rabies, cholera, typhoid fever, and yellow fever before travelling to Sudan. Examination revealed pruritic erosions, crusts, and flaccid blisters primarily on the trunk and limbs. Histopathology was nonspecific, but direct immunofluorescence showed intercellular IgG, C3c, and C1q deposits. Elevated autoantibodies against desmoglein 1 (DSG1) confirmed the PF diagnosis. The patient responded well to oral prednisone and topical treatments, with complete resolution of symptoms within six months. The aetiology of pemphigus remains unclear, but vaccines can nonspecifically activate the immune system, potentially triggering pemphigus in predisposed individuals. This case highlights the need to consider pemphigus as a potential adverse effect of vaccination.

Article available in PDF format

View PDF Download PDF file

References

  1. Bellaney GJ, Rycroft RJ. Pemphigus vulgaris following a hyperimmune response to typhoid booster. Clin Exp Dermatol. 1996; 21(6): 434–436.
  2. Mignogna MD, Lo Muzio L, Ruocco E. Pemphigus induction by influenza vaccination. Int J Dermatol. 2000; 39(10): 800.
  3. Cozzani E, Cacciapuoti M, Parodi A, et al. Pemphigus following tetanus and diphtheria vaccination. Br J Dermatol. 2002; 147(1): 188–189.
  4. Muellenhoff M, Cukrowski T, Morgan M, et al. Oral pemphigus vulgaris after anthrax vaccine administration: association or coincidence? J Am Acad Dermatol. 2004; 50(1): 136–139.
  5. Berkun Y, Mimouni D, Shoenfeld Y. Pemphigus following hepatitis B vaccination--coincidence or causality? Autoimmunity. 2005; 38(2): 117–119.
  6. Yalçin B, Alli N. Pemphigus vulgaris following antirabies vaccination. J Dermatol. 2007; 34(10): 734–735.
  7. Albavera Giles J, Hierro Orozco S, Achell Nava L, et al. Pénfigo vulgar inducido por la vacuna contra la influenza estacional. Dermatología. 2012; 56(5): 323–326.
  8. Hviid A, Svanström H, Scheller NM, et al. Human papillomavirus vaccination of adult women and risk of autoimmune and neurological diseases. J Intern Med. 2018; 283(2): 154–165.
  9. Gupta M, Sharma R, Tegta G, et al. Vaccine-induced childhood pemphigus vulgaris: A case report in a 5-year-old female child. Indian J Paediatr Dermatol. 2020; 21(4): 340.
  10. Tavakolpour S. Pemphigus trigger factors: special focus on pemphigus vulgaris and pemphigus foliaceus. Arch Dermatol Res. 2018; 310(2): 95–106.
  11. Damiani G, Pacifico A, Pelloni F, et al. The first dose of COVID-19 vaccine may trigger pemphigus and bullous pemphigoid flares: is the second dose therefore contraindicated? J Eur Acad Dermatol Venereol. 2021; 35(10): e645–e647.
  12. Solimani F, Mansour Y, Didona D, et al. Development of severe pemphigus vulgaris following SARS-CoV-2 vaccination with BNT162b2. J Eur Acad Dermatol Venereol. 2021; 35(10): e649–e651.
  13. Thongprasom K, Pengpis N, Phattarataratip E, et al. Oral pemphigus after COVID-19 vaccination. Oral Dis. 2022; 28 Suppl 2: 2597–2598.
  14. Lua AC, Ong FL, Choo KJ, et al. An unusual presentation of pemphigus foliaceus following COVID-19 vaccination. Australas J Dermatol. 2022; 63(1): 128–130.
  15. Hatami P, Balighi K, Nicknam Asl H, et al. COVID vaccination in patients under treatment with rituximab: a presentation of two cases from iran and a review of the current knowledge with a specific focus on pemphigus. Dermatol Ther. 2022; 35(1): e15216.
  16. Knechtl GV, Seyed Jafari SM, Berger T, et al. Development of pemphigus vulgaris following mRNA SARS-CoV-19 BNT162b2 vaccination in an 89-year-old patient. J Eur Acad Dermatol Venereol. 2022; 36(4): e251–e253.
  17. Koutlas IG, Camara R, Argyris PP, et al. Development of pemphigus vulgaris after the second dose of the mRNA-1273 SARS-Cov-2 vaccine. Oral Dis. 2022; 28 Suppl 2: 2612–2613.
  18. Akoglu G. Pemphigus vulgaris after SARS-CoV-2 vaccination: a case with new-onset and two cases with severe aggravation. Dermatol Ther. 2022; 35(5): e15396.
  19. Calabria E, Canfora F, Mascolo M, et al. Autoimmune mucocutaneous blistering diseases after SARS-CoV-2 vaccination: a case report of pemphigus vulgaris and a literature review. Pathol Res Pract. 2022; 232: 153834.
  20. Saffarian Z, Samii R, Ghanadan A, et al. De novo severe pemphigus vulgaris following SARS-CoV-2 vaccination with BBIBP-CorV. Dermatol Ther. 2022; 35(6): e15448.
  21. Yıldırıcı Ş, Yaylı S, Demirkesen C, et al. New onset of pemphigus foliaceus following BNT162b2 vaccine. Dermatol Ther. 2022; 35(5): e15381.
  22. Falcinelli F, Lamberti A, Cota C, et al. Reply to 'development of severe pemphigus vulgaris following SARS-CoV-2 vaccination with BNT162b2' by Solimani F et al. J Eur Acad Dermatol Venereol. 2022; 36(12): e976–e978.
  23. Gui H, Young PA, So JY, et al. New-onset pemphigus vegetans and pemphigus foliaceus after SARS-CoV-2 vaccination: a report of 2 cases. JAAD Case Rep. 2022; 27: 94–98.
  24. Hali F, Araqi L, Marnissi F, et al. Autoimmune bullous dermatosis following COVID-19 vaccination: a series of five cases. Cureus. 2022; 14(3): e23127.
  25. Corrá A, Barei F, Genovese G, et al. Five cases of new-onset pemphigus following vaccinations against coronavirus disease 2019. J Dermatol. 2023; 50(2): 229–233.
  26. Aryanian Z, Balighi K, Azizpour A, et al. Coexistence of pemphigus vulgaris and lichen planus following COVID-19 vaccination. Case Rep Dermatol Med. 2022; 2022: 2324212.
  27. Singh A, Bharadwaj SJ, Chirayath AG, et al. Development of severe pemphigus vulgaris following ChAdOx1 nCoV-19 vaccination and review of literature. J Cosmet Dermatol. 2022; 21(6): 2311–2314.
  28. Pourani M, Bidari-Zerehpoosh F, Ayatollahi A, et al. New onset of pemphigus foliaceus following BBIBP COVID-19 vaccine. Dermatol Ther. 2022; 35(11): e15816.
  29. Reis J, Nogueira M, Figueiras O, et al. Pemphigus foliaceous after mRNA COVID-19 vaccine. Eur J Dermatol. 2022; 32(3): 428–429.
  30. Rouatbi J, Aounallah A, Lahouel M, et al. Two cases with new onset of pemphigus foliaceus after SARS-CoV-2 vaccination. Dermatol Ther. 2022; 35(11): e15827.
  31. Agharbi FZ, Basri G, Chiheb S. Pemphigus vulgaris following second dose of mRNA-(Pfizer-BioNTech) COVID-19 vaccine. Dermatol Ther. 2022; 35(10): e15769.
  32. Shakoei S, Kalantari Y, Nasimi M, et al. Cutaneous manifestations following COVID-19 vaccination: a report of 25 cases. Dermatol Ther. 2022; 35(8): e15651.
  33. Alami S, Benzekri L, Senouci K, et al. Pemphigus foliaceus triggered after inactivated SARS-CoV-2 vaccine: coincidence or causal link? Dermatol Ther. 2022; 35(10): e15775.
  34. Norimatsu Y, Yoshizaki A, Yamada T, et al. Pemphigus vulgaris with advanced hypopharyngeal and gastric cancer following SARS-CoV-2 vaccination. J Dermatol. 2023; 50(2): e74–e75.
  35. Almasi-Nasrabadi M, Ayyalaraju RS, Sharma A, et al. New onset pemphigus foliaceus following AstraZeneca COVID-19 vaccination. J Eur Acad Dermatol Venereol. 2023; 37(1): e1–e3.
  36. Pham NN, Nguyen TT, Vu TT, et al. Pemphigus foliaceus after COVID-19 vaccination: a report of two cases. Case Rep Dermatol Med. 2023; 2023: 1218388.
  37. Petti S, Arduino PG. New-onset pemphigus vulgaris and pemphigus foliaceus following COVID-19 infection and vaccination, systematic review of case reports and a causal hypothesis. J Eur Acad Dermatol Venereol. 2023; 37(11): e1256–e1260.
  38. Wolf R, Tamir A, Brenner S. Drug-induced versus drug-triggered pemphigus. Dermatologica. 1991; 182(4): 207–210.
  39. Brenner S, Goldberg I. Drug-induced pemphigus. Clin Dermatol. 2011; 29(4): 455–457.