Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2023 Jan;50(1):24-28.
doi: 10.1111/cup.14305. Epub 2022 Aug 23.

Eosinophil-rich linear IgA bullous dermatosis induced by mRNA COVID-19 booster vaccine

Affiliations
Free PMC article
Case Reports

Eosinophil-rich linear IgA bullous dermatosis induced by mRNA COVID-19 booster vaccine

William J Nahm et al. J Cutan Pathol. 2023 Jan.
Free PMC article

Abstract

We present a case of eosinophil-rich linear IgA bullous disease (LABD) following the administration of a messenger RNA COVID-19 booster vaccine. A 66-year-old man presented to the emergency department with a 3-week history of a pruritic blistering rash characterized by fluid-filled bullae and multiple annular and polycyclic plaques. He was initially diagnosed with bullous pemphigoid based on a biopsy showing a subepidermal blister with numerous eosinophils. However, direct immunofluorescence studies showed linear IgA and IgM deposition along the basement membrane zone with no immunoreactivity for C3 or IgG. Additionally, indirect immunofluorescence was positive for IgA basement membrane zone antibody. The patient was subsequently diagnosed with LABD and initiated on dapsone therapy with resolution of his lesions at 3-month follow-up. This case illustrates the growing number of autoimmune blistering adverse cutaneous reactions from vaccination. Dermatopathologists should be aware that features of autoimmune blistering diseases can overlap and may not be distinguishable based on these histopathological findings alone. Confirmation with direct immunofluorescence and/or serological studies may be necessary for accurate diagnosis.

Keywords: COVID-19; Moderna booster; direct immunofluorescence; linear IgA bullous dermatosis; vaccine.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
(A) Polycyclic erythematous plaques with central clearing were noticed on the left arm. (B) Yellow tense fluid‐filled bullae were present on a background of annular and polycyclic erythematous plaques on the left thigh.
FIGURE 2
FIGURE 2
(A) Lesional skin specimen with H&E stain revealed broad subepidermal blister with a superficial perivascular infiltrate (×4). (B) Numerous eosinophils are seen within the blister cavity (×20). (C) Both eosinophils and neutrophils are seen lining the dermal‐epidermal junction and within dermal papillae (×40).
FIGURE 3
FIGURE 3
(A) Direct Immunofluorescence of clinically perilesional skin revealed a strong linear deposition of IgA (×40) and (B) weaker IgM co‐reactivity along the dermal‐epidermal junction (×40).

Similar articles

References

    1. 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. doi:10.1016/j.jaad.2021.03.092 - DOI - PMC - PubMed
    1. Catala A, Munoz‐Santos C, Galvan‐Casas C, et al. Cutaneous reactions after SARS‐CoV‐2 vaccination: a cross‐sectional Spanish nationwide study of 405 cases. Br J Dermatol. 2022;186(1):142‐152. doi:10.1111/bjd.20639 - DOI - PMC - PubMed
    1. Bataille V, Puig S. COVID‐19 vaccines and skin manifestations. Br J Dermatol. 2022;186(1):15. doi:10.1111/bjd.20807 - DOI - PMC - PubMed
    1. Robinson LB, Fu X, Hashimoto D, et al. Incidence of cutaneous reactions after messenger RNA COVID‐19 vaccines. JAMA Dermatol. 2021;157(8):1000‐1002. doi:10.1001/jamadermatol.2021.2114 - DOI - PMC - PubMed
    1. Maronese CA, Caproni M, Moltrasio C, et al. Bullous pemphigoid associated with COVID‐19 vaccines: an Italian multicentre study. Front Med. 2022;9:841506. doi:10.3389/fmed.2022.841506 - DOI - PMC - PubMed

Publication types