Three cases of drug-induced hypersensitivity syndrome associated with mRNA-based coronavirus disease 2019 vaccines

Abstract

Drug-induced hypersensitivity syndrome (DiHS) is a severe drug eruption that can induce reactivation of herpesviruses such as human herpesvirus 6, resulting in symptom flare-up and organ damage. DiHS is known as drug reaction with eosinophilia and systemic symptoms (DRESS) in Europe. We report three cases of DiHS that could have been triggered by mRNA-based coronavirus disease 2019 (COVID-19) vaccines. In these three patients, symptoms of DiHS developed 2-6 days after the first dose of an mRNA-based COVID-19 vaccine. Although there have been no reports of DiHS/DRESS induced by mRNA-based COVID-19 vaccines in domestic and international journals despite the progress in vaccination worldwide, we speculate that mRNA-based COVID-19 vaccines might have triggered the development of DiHS/DRESS in our patients. In the current coronavirus epidemic, it might be important to assess mRNA-based COVID-19 vaccination status and date of vaccination when evaluating a patient with DiHS/DRESS.

Keywords: coronavirus disease 2019; drug-induced hypersensitivity syndrome; human herpesvirus 6; mRNA; vaccine.

FIGURE 1

(a–d) Diffuse redness of the entire body with many scratch marks and swelling of the face in patient 1. (e) Redness on the hard palate in patient 1. (f) In patient 1, histopathological findings included an infiltration of lymphocytes surrounding the vessels in the dermis and mild vacuolar changes in the epidermis. There was no atypia of the infiltrating cells (hematoxylin–eosin, original magnification × 200)

FIGURE 2

(a–d) Diffuse redness of the entire body with many scratch marks and swelling of the face and lower legs in patient 2. (e) In patient 2, histopathological findings included an infiltration of lymphocytes surrounding the vessels in the dermis (hematoxylin–eosin [HE], original magnification × 200.) (f,g) In patient 3, histopathological findings in the dermis included an infiltration of lymphocytes and eosinophils surrounding the vessels with hemorrhage. In the epidermis, there were mild vacuolar changes and lymphocytic infiltration (HE, [f] × 100, [g] × 200)