LESIONS MIMICKING KAPOSI SARCOMA IN A WOMAN LIVING WITH HIV FOLLOWING PFIZER-BIONTECH COVID-19 VACCINATION

Introduction

A spectrum of skin reactions following mRNA COVID vaccinations have been reported that can mimic dermatological manifestations of Human Immunodeficiency Virus (HIV) infection. Case Description A 47-year-old Zimbabwean female living with HIV since 2011 (nadir CD4 366 cells/mm3) was seen in our HIV clinic with a widespread rash and raised, itchy lesions over her body measuring approximately 5-7mm which appeared three weeks after her first Pfizer-BioNTech COVID-19 vaccine. There was no systemic involvement. Her CD4 count was 641 cells/mm3 (44%) with a fully suppressed viral load on antiretroviral therapy since June 2015 with no other pertinent medical history. There was no response to topical anti-fungal therapy but symptomatic relief with anti-pruritic and anti-histamine was noted. Treatment with oral erythromycin 500mg four times a day for two weeks decreased the size of the lesions and improved the rash. A punch biopsy of pale brown skin at this time was performed with appearances in keeping with those of a lichenoid pattern of inflammation. Our patient continues to improve with erythromycin.Topical or systemic corticosteroid therapy can be considered to further ameliorate her condition.

Discussion

Lichenoid drug eruptions are well recognized. Our case demonstrates such a reaction to the Pfizer-BioNTech COVID-19 vaccination which adds to cases described in the contemporary medical literature. It is vital to recognize this complication in our specialty as lesions may mimic lichen planus clinically and histologically and may be mistaken for dermatological manifestations associated with HIV, including Kaposi Sarcoma (KS) and bacillary angiomatosis, which can manifest regardless of immune status.

References

Onn, P-Y, Chang, CL. Lichenoid cutaneous skin eruption and associated systemic inflammatory response following Pfizer-BioNTech mRNA COVID-19 vaccine administration. Respirology Case Reports. 2021; 9:e0860. https://doi.org/10.1002/rcr2.860 Correia, C., Fernandes, S., Soares-de-Almeida, L. and Filipe, P. (2022), Exuberant lichenoid eruption after Oxford–AstraZeneca COVID-19 vaccine: a singular case. J Eur Acad Dermatol Venereol. https://doi.org/10.1111/jdv.17872