Stevens-Johnson syndrome precipitated by Moderna Inc. COVID-19 vaccine: a case-based review of literature comparing vaccine and drug-induced Stevens-Johnson syndrome/toxic epidermal necrolysis

Abstract

The Moderna COVID-19 vaccination was approved for use in the United States in December of 2020¹ and since that time massive public health efforts have been made to vaccinate patients against the COVID-19 infection. Adverse reactions from the vaccination are well-reported and include both local skin reactions, such as pain, swelling, and erythema at the injection site, as well as systemic reactions including fever, malaise, headache, muscle aches, drowsiness, nausea, and vomiting. While severe serious cutaneous adverse reactions, such as Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN), remain rare; two cases of SJS/TEN related to COVID-19 vaccination have been reported. We herein review the two previously reported cases of SJS/TEN and report the first case of SJS precipitated by the Moderna Inc., MRNA 1273 COVID-19 vaccination in the United States. Although we review potential adverse reactions to vaccination, the benefits of COVID-19 vaccination outweigh the risks based on current data. Cases should be reported to the Vaccine Adverse Event Reporting System (https://vaers.hhs.gov/) to help public health officials recognize and track these severe but rare adverse events.

Figure 1

(a) Clinical photograph of patient's face showing dusky, pink‐purple plaques on her eyelids and cheeks with nasal and oral mucosal sloughing. (b) Clinical photograph of patient's face revealing nasal and oral mucosal sloughing

Figure 2

(a) Clinical photograph of patient's trunk showing small, dusky, purple papules coalescing into plaques. (b) Clinical photograph of patient's arms showing small, dusky, purple papules coalescing into plaques across arms

Figure 3

(a) Clinical photographs of palms showing violaceous annular lesions. (b) Clinical photographs of soles showing violaceous annular lesions

Figure 4

Histopathologic examination of right forearm skin biopsy. (a) Histopathologic slide from right forearm showing separation of the epidermis and dermis with mild chronic inflammation composed predominately of lymphocytes (hematoxylin and eosin stain x20). (b) Histopathologic slide from right forearm (hematoxylin and eosin, x100). (c) Histopathologic slide from right forearm (hematoxylin and eosin, x200). (b, c) reveal overlying confluent and full‐thickness necrosis of epidermis associated with mild perivascular infiltrate of lymphocytes and a basket weave‐type stratum corneum.