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Two cases of COVID-19 vaccine-related erythema multiforme under the administration of immune checkpoint inhibitors

Ayako Matsuo
Department of Dermatology, Faculty of Medicine, Kindai University Hospital
Chisa Nakashima
Department of Dermatology, Faculty of Medicine, Kindai University Hospital, Osaka 589-8511, Japan
Shigeto Yanagihara
Atsushi Otsuka
Received: 06 September 2024
Published: 17 October 2023

Abstract

The COVID-19 pandemic has increased mRNA vaccine usage and revealed various cutaneous adverse events, such as injection site reactions, urticaria, and morbilliform eruptions. Multiple centers have reported erythema multiforme (EM) as a COVID-19 vaccine-associated adverse event. Our center observed two cases of EM in patients receiving immune checkpoint inhibitors (ICI) after COVID-19 vaccination. Notably, ICI administration is known to cause cutaneous adverse events, including EM. A previous report indicated that administering COVID-19 vaccination to patients receiving ICI treatment could promote severe systemic symptoms. This raise concerns that COVID-19 vaccination might rapidly worsen skin rashes in these patients. Our report demonstrates that skin rash related to COVID-19 vaccine-induced EM in ICI-treated patients does not significantly differ from that of COVID-19 vaccine-related EM. Additionally, in both cases, the skin rash resolved without exacerbation. Further research is necessary to determine optimal management strategies. However, our findings provide reassurance that COVID-19 vaccination is safe in ICI-treated patients and should not be avoided.

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