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Sanomachi T, Sumiyoshi Okuma H, Yonemori K. COVID arm that appeared in the contralateral upper extremity after mRNA-1273 booster inoculation. Int Cancer Conf J 2023; 12:216-219. [PMID: 36843626 PMCID: PMC9939858 DOI: 10.1007/s13691-023-00598-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/04/2023] [Indexed: 02/25/2023] Open
Abstract
We report the findings of a 60-year-old female patient with metastatic breast cancer who presented with severe edema and neuralgia in the contralateral arm after receiving the third COVID-19 vaccine dose. The patient did not report any reaction to the first two doses of the BNT162b2 (Pfizer-BioNTech) vaccine. However, after a booster dose with the mRNA-1273 (Moderna) vaccine, the patient developed a high fever persisting for one week after the shot, and sequential severe swelling, inflammation, and pain in the contralateral arm lasting for three weeks.
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Affiliation(s)
- Tomomi Sanomachi
- grid.272242.30000 0001 2168 5385Department of Medical Oncology, Department of International Clinical Development, Clinical Research Support Office, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, Japan
| | - Hitomi Sumiyoshi Okuma
- grid.272242.30000 0001 2168 5385Department of Medical Oncology, Department of International Clinical Development, Clinical Research Support Office, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, Japan
| | - Kan Yonemori
- grid.272242.30000 0001 2168 5385Department of Medical Oncology, Department of International Clinical Development, Clinical Research Support Office, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, Japan
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Agustin M, Trifitriana M, Danarti R. COVID arm as a common cutaneous manifestation after mRNA-1273 vaccination: a systematic review. BMC Infect Dis 2023; 23:7. [PMID: 36609222 PMCID: PMC9817307 DOI: 10.1186/s12879-022-07973-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/26/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND By August 2022, CoronaVirus Disease-2019 (COVID-19) had caused 600 million illnesses and 6.5 million fatalities globally. A massive vaccination program is being implemented worldwide to suppress this condition. Several works of literature stated that mRNA COVID-19 vaccination, specifically with the mRNA-1273 vaccine, is followed by clear evidence of the COVID arm effects associated with this vaccine. OBJECTIVE To analyze the latest evidence of COVID arm as a common effect of mRNA-1273 vaccination with the ultimate goal of improving vaccine counseling to help healthcare professionals and reassure patients. METHODS A comprehensive search was performed on topics that assess the COVID arm as a cutaneous manifestation following mRNA-1273 vaccination from inception up until July 2022. RESULTS Eighteen studies with a total of 1129 participants after the first and second dose of mRNA-1273 vaccination reported that most participants had COVID arm following the first dose administration. The characteristics of the patients were a mean age of 43.8 years old, and females represented ≥ 50% in most studies, with a mean onset of 6.9 days after the first dose administration. Symptoms resolved within seven days following the treatment and were harmless. CONCLUSIONS This study found that the COVID arm condition is most common following the first mRNA-1273 vaccination in the female and middle-aged group. The correlation between demographic variables and COVID arm risk elucidates that the reaction is a type IV allergic skin reaction.
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Affiliation(s)
- Maulidina Agustin
- grid.8570.a0000 0001 2152 4506Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Monica Trifitriana
- grid.108126.c0000 0001 0557 0975Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia
| | - Retno Danarti
- grid.8570.a0000 0001 2152 4506Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia ,grid.8570.a0000 0001 2152 4506Department of Dermatology and Venereology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Gedung Radiopoetro Lantai 3, Jalan Farmako, Sekip, Yogyakarta, 55281 Indonesia
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Pesqué D, Pujol RM, Marcantonio O, Vidal-Navarro A, Ramada JM, Arderiu-Formentí A, Albalat-Torres A, Serra C, Giménez-Arnau AM. Study of Excipients in Delayed Skin Reactions to mRNA Vaccines: Positive Delayed Intradermal Reactions to Polyethylene Glycol Provide New Insights for COVID-19 Arm. Vaccines (Basel) 2022; 10. [PMID: 36560458 DOI: 10.3390/vaccines10122048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Skin local reactions to mRNA COVID-19 vaccines have been linked to the use of vaccine excipients. The aim of the study is to evaluate the role of skin testing excipients in delayed skin reactions due to mRNA COVID-19 vaccines. METHODS Skin testing among a group of healthcare workers with skin reactions due to mRNA vaccines was performed. Patch testing and intradermal testing (IDT) with polyethylene glycol (PEG)-400, PEG-2000, trometamol, and 1,2-dimyristoyl-sn-glycero-3-phosphocholine were performed. Healthcare workers without skin reactions to vaccines were used for skin testing as controls. RESULTS Thirty-one healthcare workers (from a total of 4315 vaccinated healthcare workers) experienced cutaneous adverse vaccine reactions. Skin testing was performed in sixteen of the healthcare workers (11 delayed large local reactions (DLLR) and 5 widespread reactions). Positive IDT for PEG-2000 1% in DLLR was seen in 10 (90.9%) patients, in comparison with one (16.6%) individual with a delayed widespread reaction. Delayed positive IDT reactions for PEG-2000 1% on day 2 were observed in three (27.3%) patients with DLLR. Patch testing of the excipients was negative. Among 10 controls, only one exhibited a transient positive IDT reaction to PEG-2000 1%. CONCLUSIONS Immediate and delayed reactions to IDT are frequently detected in patients with DLLR. The observation of positive delayed intradermal reactions to PEG disclosed only in patients with DLLR reinforces a possible role of PEG in the development of these reactions. Skin testing of other excipients is of little importance in clinical practice.
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Pendlebury GA, Oro P, Haynes W, Merideth D, Bartling S, Bongiorno MA. The Impact of COVID-19 Pandemic on Dermatological Conditions: A Novel, Comprehensive Review. Dermatopathology (Basel) 2022; 9:212-243. [PMID: 35892480 PMCID: PMC9326733 DOI: 10.3390/dermatopathology9030027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 01/09/2023] Open
Abstract
Background: The earliest cases of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China, in December 2019. Since the declaration as a pandemic on 11 March 2020, further dermatological conditions continue to be documented. We herein present a novel literature review of dermatological manifestations associated with the Coronavirus Disease 2019 (COVID-19) pandemic. To date, this literature review is the first broad-spectrum examination that analyzes a range of dermatological manifestations related to the COVID-19 pandemic: infection, vaccinations, personal protective equipment (PPE), and psychosocial factors. Methods: A detailed literature search was conducted using key terms for cutaneous manifestations associated with the scope of this review. The search retrieved 2199 articles. Results: The COVID-19 pandemic has triggered a significant range of dermatologic sequela. Etiologies of lesions continue to be investigated. Proposed mechanisms include inflammatory response to spike protein, vitamin D deficiency, ACE2 receptor activation, androgen levels, and increased psychological stress. One prominent mechanism describes viral spike protein invasion into the dermis by binding to the angiotensin-converting enzyme 2 (ACE-2) receptors in keratinocytes, with a secondary immunological response. Conclusions: Dermatologists play an integral role in the proper diagnosis and treatment of COVID-related lesions. Early treatment regimens and timely prophylaxis have been shown to safely reduce infection-related dermatological sequelae. Additional investigations and data collection can reduce disease burden and improve overall prognosis.
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Affiliation(s)
- Gehan A. Pendlebury
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
| | - Peter Oro
- School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, AZ 85206, USA; (P.O.); (W.H.); (D.M.)
| | - William Haynes
- School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, AZ 85206, USA; (P.O.); (W.H.); (D.M.)
| | - Drew Merideth
- School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, AZ 85206, USA; (P.O.); (W.H.); (D.M.)
| | - Samantha Bartling
- Department of Dermatology, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA; (S.B.); (M.A.B.)
| | - Michelle A. Bongiorno
- Department of Dermatology, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA; (S.B.); (M.A.B.)
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Affiliation(s)
- Daisuke Ikechi
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Japan
| | - Hideki Hashimoto
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Japan
- Department of Infectious Diseases, The University of Tokyo Hospital, Japan
| | - Hidehiko Nakano
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Japan
| | - Kensuke Nakamura
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Japan
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Prasad S, McMahon DE, Tyagi A, Ali R, Singh R, Rosenbach M, Lim HW, Fox LP, Blumenthal K, Hruza GJ, French LE, Freeman EE. Cutaneous Reactions Following Booster Dose Administration of COVID-19 mRNA Vaccine: a first look from the AAD/ILDS Registry. JAAD Int 2022; 8:49-51. [PMID: 35498758 PMCID: PMC9040485 DOI: 10.1016/j.jdin.2022.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Sonya Prasad
- Massachusetts General Hospital, Harvard Medical School, Boston, MA.,Icahn School of Medicine, The Mount Sinai Hospital, New York, NY
| | - Devon E McMahon
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Anisha Tyagi
- Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, Boston, MA
| | - Rowanne Ali
- Massachusetts General Hospital, Harvard Medical School, Boston, MA.,George Washington University School of Medicine, Washington D.C
| | - Rhea Singh
- Massachusetts General Hospital, Harvard Medical School, Boston, MA.,Virginia Commonwealth University School of Medicine, Richmond, VA
| | | | - Henry W Lim
- Department of Dermatology, Henry Ford Health System, Detroit, MI
| | - Lindy P Fox
- Department of Dermatology, University of California San Francisco, San Francisco, CA
| | | | - George J Hruza
- Department of Dermatology, St. Louis University, St. Louis, MO
| | - Lars E French
- Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany.,Dr. Philip Frost, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Esther E Freeman
- Massachusetts General Hospital, Harvard Medical School, Boston, MA.,Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, Boston, MA
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Hibino M, Ishihara T, Iwata M, Doi Y. Delayed Injection Site Reaction After mRNA-1273 Vaccination in Japan: A Retrospective, Cross-Sectional Study. Open Forum Infect Dis 2021; 8:ofab497. [PMID: 34651054 PMCID: PMC8507458 DOI: 10.1093/ofid/ofab497] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 09/24/2021] [Indexed: 11/24/2022] Open
Abstract
The incidence of delayed injection site reaction after the first dose of mRNA-1273 vaccine was 12.5% among females and 1.5% among males in a cohort of primarily elderly Japanese. After the second dose, 48.4% of those who could be contacted reported recurrence. The reaction may be relatively common among Asian females.
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Affiliation(s)
- Masaya Hibino
- Department of Emergency and General Internal Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Takuma Ishihara
- Innovative and Clinical Research Promotion Center, Gifu University Hospital, Yanagido, Gifu, Japan
| | - Mitsunaga Iwata
- Department of Emergency and General Internal Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Yohei Doi
- Department of Microbiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.,Department of Infectious Diseases, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.,Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Saifuddin A, Koesnoe S, Kurniati N, Sirait S, Arisanty R, Yunihastuti E. COVID Arm After Moderna Booster in Healthcare Worker: A Case Report. Acta Med Indones 2021; 53:326-330. [PMID: 34611073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
SARS CoV-2 virus has infected more than 200 million people worldwide and more than 4.4 million in Indonesia. The vaccination program has become one of the solutions launched by many countries globally, including Indonesia, to reduce the transmission rate of COVID-19. Various vaccination platforms are produced, such as inactivated, viral vector, mRNA, and protein subunit. The vaccination booster program with mRNA platform (Moderna) was launched by the Indonesian government to give better protection for health care workers, particularly from delta variant. In this case report, we discuss one of the typical side effects of Moderna vaccine, which is referred to as the COVID arm.
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Affiliation(s)
- Anshari Saifuddin
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
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Lindgren AL, Austin AH, Welsh KM. COVID Arm: Delayed Hypersensitivity Reactions to SARS-CoV-2 Vaccines Misdiagnosed as Cellulitis. J Prim Care Community Health 2021; 12:21501327211024431. [PMID: 34120504 PMCID: PMC8202256 DOI: 10.1177/21501327211024431] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The term “COVID arm” has been coined to describe a harmless delayed hypersensitivity reaction occurring approximately a week after administration of the novel SARS-CoV-2 mRNA vaccine. It appears as a red, warm, pruritic, indurated, or swollen area in the vicinity of the vaccine site. These reactions, especially if accompanied by systemic symptoms, have been mistaken for cellulitis. We report 3 cases of COVID arm, 2 of which were mistaken for cellulitis. Distinguishing features of COVID arm from cellulitis include pruritus as a common finding, occurrence approximately a week after vaccination, a lack of progression of symptoms, rapid response to topical steroids, and/or spontaneous resolution usually over 4 to 5 days. Practice Points: • Patients receiving SARS-CoV-2 vaccines may experience delayed hypersensitivity reactions characterized by erythema, swelling, and itching occurring near the vaccination site (COVID arm), approximately a week after vaccination. • Clinicians can distinguish SARS-CoV-2 vaccine reactions from cellulitis by the time of onset (approximately a week vs 5 days), by the lack of progression of symptoms, and resolution over 4 to 5 days. • Severe cases of COVID arm may be treated with topical steroids.
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