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Erythema nodosum induced by Covid-19 Pfizer-BioNTech mRNA Vaccine
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  • FERDAOUS CHAHED,
  • Najah Ben Fadhel,
  • Haifa Ben Romdhane,
  • Monia Youssef,
  • Amel Chaabane,
  • Karim Aouam,
  • Nadia Ben fredj
FERDAOUS CHAHED
Fattouma Bourguiba University Hospital of Monastir

Corresponding Author:[email protected]

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Najah Ben Fadhel
Fattouma Bourguiba University Hospital of Monastir
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Haifa Ben Romdhane
Fattouma Bourguiba University Hospital of Monastir
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Monia Youssef
Fattouma Bourguiba University Hospital of Monastir
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Amel Chaabane
Fattouma Bourguiba University Hospital of Monastir
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Karim Aouam
Fattouma Bourguiba University Hospital of Monastir
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Nadia Ben fredj
Fattouma Bourguiba University Hospital of Monastir
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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.
22 Dec 2021Submitted to British Journal of Clinical Pharmacology
24 Dec 2021Submission Checks Completed
24 Dec 2021Assigned to Editor
12 Jan 2022Reviewer(s) Assigned
18 Feb 2022Review(s) Completed, Editorial Evaluation Pending
02 Mar 2022Editorial Decision: Revise Major
19 Mar 20221st Revision Received
24 Mar 2022Submission Checks Completed
24 Mar 2022Assigned to Editor
24 Mar 2022Review(s) Completed, Editorial Evaluation Pending
26 Mar 2022Editorial Decision: Revise Minor
28 Mar 20222nd Revision Received
29 Mar 2022Submission Checks Completed
29 Mar 2022Assigned to Editor
30 Mar 2022Review(s) Completed, Editorial Evaluation Pending
31 Mar 2022Editorial Decision: Accept