Case presentation
Our patient is a 67-year-old man with a history of hypertension who
presented to our clinic with a history of fever and cutaneous eruptions.
He had received the first dose of Sinopharm COVID-19 vaccine
(BBIBP-CorV) with a dose of 0.5 mL given intramuscularly six days before
the development of his lesions. His manifestations started with fever
and erythema patches on his back followed by bullous lesions on the
lower extremities. He was seen in another health care center and was
given acetaminophen, cetirizine, and vitamines and did not notice any
improvement. Seven days after vaccination, lesions developed on his
body, and the genital mucosa was involved.
He had no history of taking any new medication in the past one month
before the development of the skin lesions and he had a history of
COVID-19 infection 3 months ago.
On physical examination, all mucosal surfaces were involved. Bilateral
conjunctivitis with purulent and oral and genital ulceration and
hemorrhagic crusting over his lips.
He had numerous purpuric and dusky patches involving the back, chest,
abdomen, both extremities, and face, with flaccid bullae and areas of
epidermal detachment. He had positive Nikolsky’s sign. His body surface
area (BSA) involvement is estimated to be more than 30%. Laboratory
findings showed elevated D-dimer [2626], erythrocyte sedimentation
rate (ESR)[64 mm/h], C-reactive protein (CRP)levels [70 mg/l].
(Figure 1)
The Severity-of-Illness Score for Toxic Epidermal Necrolysis (SCORTEN)
score was two on the day of her admission since she was older than 40
and detached body surface more than 10%. Viral markers and COVID-19 (
polymerase chain reaction) PCR was negative. He has been treated with
dexamethasone 4 mg twice daily and cyclosporine 200 mg daily for 6 days.
His lesions stopped developing after four days, and complete healing was
noted after 14 days.
Ophthalmic antibiotics and corticosteroids eye drop was used for
conjunctivitis treatment. On the other hand, elevated D-Dimer levels
prompted the clinicians to evaluate and rule out Deep vein thrombosis
(DVT) and pulmonary thromboembolism (PTE). No signs of DVT were found in
ultrasonographic evaluations of lower limbs, PTE was also ruled out as
ventilation and perfusion scan was carried out. The patient is currently
under observation and the lesions have been completely cured.
(Figure 1)