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Case Reports
. 2022 Mar 24;22(1):90.
doi: 10.1186/s12903-022-02124-2.

Oral erythema multiforme after Pfizer-BioNTech COVID-19 vaccination: a report of four cases

Massimo Petruzzi  1   2 , Sara Galleggiante  1 , Sabrina Messina  1 , Fedora Della Vella  3
Affiliations
Case Reports

Oral erythema multiforme after Pfizer-BioNTech COVID-19 vaccination: a report of four cases

Massimo Petruzzi et al. BMC Oral Health. .

Abstract

Background: The 2019 Coronavirus disease (Covid-19) has affected thousands of people worldwide. To date, vaccines appear to be the only method to prevent and reduce mortality. Four vaccinations have been outwardly approved by European Medicine Agency (EMA) in Europe: BNT162b2 (Comirnaty-BioNTech/Pfizer), mRNA-1273 (Spikevax-Moderna), ChAdOx1 (VaxzevriaAstrazeneca), and Ad26.COV2-S (Janssen-Johnson&Johnson). After vaccination, local and systemic adverse effects can occur. Cutaneous reactions like urticaria, local injection site pain, morbilliform rash have been documented after vaccination.

Cases presentation: We report four cases of oral erythema multiforme flare arising after BNT162b2 vaccination administration. All the patients denied previous erythema-like and herpetic manifestations history. Two of the reported cases (number 1 and 2) presented with both oral and cutaneous lesions, while cases 3 and 4 showed only oral manifestations. Three of the cases presented the erythema after the first vaccination dosage administration, only one case reported lesions after the second vaccination dosage administration. All the cases were treated with prednisone via oral administration and topical 0.05% clobetasol ointment.

Conclusions: The present reports represent some of the few cases of erythema multiforme occurring as a side effect of the BNT162b2 COVID-19 vaccination. The causal role of the vaccine for the erythema multiforme has not been proven yet; nevertheless, it is not uncommon for medications to trigger this disease. The vaccine could surface a silent herpes virus infection, which would induce the erythema multiforme instead.

Keywords: Adverse reaction; BioNTech/Pfizer; Case report; Covid-19 vaccine; Erythema multiforme.

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Conflict of interest statement

MP has no competing interests to declare. SG has no competing interests to declare. SM has no competing interests to declare. FDV has no competing interests to declare.

Figures

Fig. 1
Fig. 1
Squamous crusted lesions and erythematous areas on lips mucosa and vermilion
Fig. 2
Fig. 2
Squamous crusted lesions on lips mucosa and bullous lesions on the mouth floor mucosa
Fig. 3
Fig. 3
Bullous-erythematosus lesions on the left cheek mucosa
Fig. 4
Fig. 4
Bullous-erythematosus lesions on the right cheek mucosa
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Fig. 5
Erythematous lesions on the gingival mucosa
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Fig. 6
Typical erythema multiforme target lesions occurring on knees skin
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Fig. 7
Tipical target erythema multiforme lesion on dorsal hand skin
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Fig. 8
Erythematous and bullous lesions on dorsal hand skin
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Fig. 9
Erythematous and squamous crusted lesions on lips mucosa and vermilion
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Fig. 10
Multiple erythematous skin lesions
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Fig. 11
Improvement of labial and mucosal lesions after prednisone treatment
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Fig. 12
Multiple bullous and erythematous lesions on the ventral tongue
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Fig. 13
Multiple bullous and erythematous lesions on the ventral tongue
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Fig. 14
Squamous-crostous and bullous lesions on the lip’s mucosa
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Fig. 15
Bullous and erythematous lesions on the cheek and inner lip’s mucosa
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Fig. 16
Bullous and erythematous lesions on the cheek and inner lip’s mucosa
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Fig. 17
Erythematous lesions on the dorsal tongue mucosa
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Fig. 18
Erythematous-bullous lesions on the gingival mucosa
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Fig. 19
Erythematous lesions on the soft palate
See this image and copyright information in PMC

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