To date, a number of orofacial manifestations COVID‐19 vaccine‐related have been reported, ranging from erythema multiforme‐like reactions, oral lichenoid lesions, and oral mucositis (Di Spirito et al., 2022). Potential pathogenic mechanisms underlying the occurrence of adverse events in COVID‐19 vaccinated patients are far to be clarified, and only a temporal correlation may be suggested. (a, b) Intraoral photograph showing blisters of the upper and lower gingivae (c) direct immunofluorescence microscopy demonstrated linear staining of IgG antibodies at the basement membrane zone (d) complete clinical remission of the bullous lesions. The patient is currently on follow‐up visit every 2 weeks in our department. Therefore, 0.5 mg/kg of systemic prednisone (25 mg/day) was prescribed for 1 week with progressively tapered dosage achieving a complete clinical remission in 3 weeks (Schmidt et al., 2021 Figure 1d). The patient was firstly treated with topical betamethasone sodium phosphate tablets 0.5 mg diluted in water as mouthwash three times per day for 3 weeks without response. Therefore, on account of the timing of the bullous lesions onset, a diagnosis of mucous membrane pemphigoid (MMP) localized at the oral mucosa after SARS‐CoV‐2 vaccination was made. The ELISA test performed on the patient's serum, detected high level of anti‐BP‐180 antibodies (116 U/mL normal <20 U/mL), while the anti‐BP‐230 antibodies titer was within the limits (5 U/mL normal <20 U/mL). Histopathology demonstrated the presence of a subepithelial detachment, while the direct immunofluorescence microscopy showed the linear deposition of IgG (Figure 1c) and IgA antibodies at the basement membrane zone and prevalent granular deposition of C3 at the same sites. A perilesional biopsy of the bullous lesions at the upper right gingiva was taken.
UNIVERSITY MAGNA GRAECIA OF CATANZARO SKIN
Other mucosal membranes and skin were unremarkable. Upon intraoral examination, generalized bullous and erythematous areas along with ulcerations at the upper and lower gingivae extended bilaterally to the vestibular fornix and to the right buccal mucosa were present (Figure 1a, b). Moreover, her medical records revealed a previous history of breast cancer on maintenance therapy with an aromatase inhibitor and of severe osteoporosis treated with denosumab. Prior to our consultation, her general physician and dentist attempted to treat her condition with courses of antibiotics and antifungal medications without achieving remission of the lesions.
She reported that the oral lesions appeared 9 days after receiving the third dose of the mRNABNT162b2 vaccine (Comirnaty®/Pfizer/BioNtech). Here, we present a case of mucous membrane pemphigoid (MMP) arising after the administration of the third dose of mRNABNT162b2 vaccine (Comirnaty®/Pfizer/BioNtech).Ī 72‐year‐old female patient was admitted to the Oral Surgery and Pathology Unit of the University of Catanzaro Magna Graecia, Italy, complaining of painful oral lesions lasting over 6 months. Nonetheless, a variety of mucocutaneous SARS‐CoV‐2 vaccine‐related adverse reactions have been constantly reported (Seirafianpour et al., 2022), including several cases of autoimmune mucocutaneous blistering diseases (Calabria et al., 2022 Maronese et al., 2022).
The vaccination campaigns against the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection have played an undisputed role in controlling the spread and severity of COVID‐19 disease worldwide (Mohammed et al., 2022).
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