Neutrophilic urticarial dermatosis following BNT162b2 (Pfizer–BioNTech) COVID?19 vaccination

We reported a patient with neutrophilic urticaria following COVID-19 vaccination who required high-dose steroid treatment. Dear Editor, Many people around the world have received and cutaneous reactions, for example, delayed significant local reaction, injection site urticarial eruption, morbilliform are widely reported. While reactions to vaccine generally minor self-limited, we report dermatosis An 86-year-old woman was brought our hospital by emergency transport due difficulty moving, fever, nonpruritic patches plaques on her whole body (Figure 1A Day 0). Within 5 h of receiving first dose (BNT162b2), she noticed erythema neck lower limbs (Day-4). Several days later, eruption became widespread, involving face, arms, chest, back. Individual lesions did not resolve after several hours. She fell unable get up, prompting son call an ambulance. Her vital signs were normal, had no breathing difficulties. Blood tests revealed high C-reactive protein level (6.9 mg/dl) white blood cell count (22,300/?l) neutrophilia (86.8%). Methylprednisolone (125 mg) administered intravenous drip. On 1, ears, trunk improved, but erythematous plaque persisted thighs 1). The skin clinically diagnosed as multiforme. Oral prednisolone (25 mg/day, 0.5 mg/kg/day) started. 2, disappeared within 24 onset, new appeared knees 2) accompanied fever (38.7°C). increased 50 mg/day (1 mg/kg/day). Pathologic analysis biopsy sample obtained from lesion thigh 1) infiltration inflammatory cells 1B,C) diffuse neutrophil nuclear dust 1D) in dermis. Neither vasculitis nor liquefaction observed. dermatosis. 3, disappeared. 19, tapered off. Neutrophilic is rare disease. Edematous erythema, similar urticaria, recurs 24-48 h, arthritis. It may be associated systemic lupus erythematosus adult-onset Still's disease.1 has yet been Shimabukuro2 that frequency anaphylaxis BNT162b2 11.1 cases per million. Urticaria observed 18 74 patients presenting BNT162b2.3 Of vaccination, only four developed second vaccination.3 In this case, (BNT162b2). This might late phase reaction recruiting neutrophils. important keep mind although usually mild, severe. Further accumulation will help elucidate underlying mechanisms Approval research protocol: N/A. Informed Consent: Obtained patient. Registry Registration No. study/trial: Animal Studies: authors declare conflict interest.