Autoimmunity‐related neutrophilic dermatosis after coronavirus disease 2019 vaccination: A case report and literature review

Autoimmune diseases triggered by coronavirus disease 2019 (COVID‐19) mRNA vaccination have been emerging. Here, we report the case of a 27‐year‐old Japanese man with autoimmunity‐related neutrophilic dermatosis, occurring as an initial cutaneous manifestation of systemic lupus erythematosus with Sjögren syndrome after the second dose of the Pfizer/BioNTech COVID‐19 vaccination. The patient presented with urticarial erythema and partially annular erythema on the trunk and extremities with severe pruritus. Histopathological analysis showed vacuolar degeneration at the dermo‐epidermal junction and interstitial neutrophil infiltration. We reviewed eight patients, including the aforementioned patient, with exacerbation or new‐onset of SLE after COVID‐19 vaccination and found the patient had relatively mild symptoms, itchy annular erythema, and positive anti‐SS‐A/SS‐B antibodies. COVID‐19 mRNA vaccination can induce the production of type‐I interferon, which plays a crucial role in the pathogenesis of SLE and may cause autoimmunity‐related neutrophilic dermatosis in susceptible individuals. In the case that itchy annular erythema develops approximately 2 weeks after the vaccination, the possibility of systemic or cutaneous lupus erythematosus should be considered. For an accurate diagnosis, dermatologists should obtain a recent vaccination history and perform complete antibody profiling and skin biopsy for patients presenting with annular or erythema multiforme‐like lesions.