Abstract: PO0104
Cutaneous Manifestations of COVID-19 Vaccine in ESRD Patients
Session Information
- COVID-19: Health Systems and More
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Coronavirus (COVID-19)
- 000 Coronavirus (COVID-19)
Authors
- Hasan, Irtiza, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, United States
- Heilig, Charles W., University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, United States
Introduction
COVID-19 vaccines including Pfizer (BNT16262) & Moderna (mRNA-1273) have been authorized for emergency use by FDA since late 2020. Although there are reported cases of cutaneous manifestation post mRNA based COVID vaccines, but literature is lacking for the same in patients with ESRD. Here we report two cases of generalized cutaneous manifestations in patients with ESRD.
Case Description
A 76-year-old female with DM, HTN, SLE (in remission) & CKD 5 was admitted with bilateral leg edema & generalized skin reaction 2 weeks post receiving 1st dose of Moderna vaccine. Skin manifestations included generalized macular & blistering lesions, painful ruptured vesicles & skin weeping. Skin biopsy revealed epidermal necrosis, neutrophilic spongiosis & negative DIF. The 2nd case was a 34-year-old male with DM, HTN & ESRD on PD who was admitted with inadequate PD due to membrane failure. Also complaint of itchy, painless maculopapular rash, which was initially localized following 1st dose of Moderna vaccine but became progressive & diffuse post 2nd dose. Biopsy was nonspecific with focal epidermal squamous atypia, overall negative DIF except C3 granular staining in basement membrane. Immunological tests failed to detect ab against infectious origin. Both cases denied oral or genital ulcers, new onset diarrhea, new medication, new sexual contact or recent travel. CBC were normal & other lab tests were negative for active immunological, autoimmune or other dermatologic disease. Both cases were considered to be related to cutaneous complication of COVID vaccine in patients with ESRD. The 1st case made significant improvement post start of hemodialysis (HD), oral & topical steroid. The 2nd case gradually improved post transition to HD & use of topical steroid.
Discussion
The majority of studies looked at skin reaction to COVID19 vaccine were in non-renal disease population & reported minor, self-limited manifestations, our case report highlights a more severe & generalized skin manifestation in ESRD. Associated factors may be related to difference in vaccine response in renal patients, alteration of immunogenic reaction in uremic environment or progression due to delayed healing & concomitant presence of edema in setting of inadequate dialysis. Clinical trials for Moderna vaccine didn't include participants with renal disease & hence insufficient to determine the pharmacology & side effect profile in this population.