Abstract
Erythema nodosum (EN), the most form of panniculitis, is mainly caused
by numerous infective (especially Beta-hemolytic streptococcal
infections) and non-infective (especially sarcoidosis) diseases and
drugs. EN associated with vaccines has been rarely reported. We describe
herein, an original clinical observation of EN induced by BNT162b2, an
mRNA vaccine. A 75-year-old woman presented with diffuse erythematous
painful rounded nodular lesions, located symmetrically over her legs.
Six days before, she had received the second dose of Covid-19 vaccine
(BNT162b2 (Pfizer–BioNTech)), followed by a sudden asthenia,
polyarthralgia, throbbing and edema over her lower limbs. She had been
given the first dose of the same Covid-19 vaccine 29 days prior to the
second without incident. General physical examination was normal. Skin
examination showed multiple, erythematous tender, nodules, 10–30 mm in
diameter, over the tibial area. Complete blood count, renal and hepatic
tests, antistreptolysin O titer, antinuclear antibody, thyroid test and
chest radiograph and PCR, were carried out, and found to be normal.
Histopathology revealed infiltration of deep dermal vessels and
subcutaneous fat with lymphomononuclear cells and neutrophils,
consistent with erythema nodosum. Treatment with analgesics led to
complete resolution of the lesion after three months. The patient has
shown no relapse after follow-up for three months. In conclusion, to our
knowledge, this is the first case of EN induced by the second dose of
BNT162b2 (Pfizer–BioNTech) Covid-19 vaccine. It is important for
clinicians to be aware of this rare, yet potential, adverse effect to
this vaccine.