Autoimmune bullous disorder flares following severe acute respiratory syndrome coronavirus 2 vaccination: a case series

Table 1 Baseline characteristics, flare onset latency, serologic results, and outcomes for three cases of flares of preexisting ABD following COVID-19 vaccination

	Age/sex/ethnicity Diagnosis/vaccine	Onset latency (dose #)	IIF/ELISA results at diagnosis (date)^a	Baseline treatment	IIF/ELISA results with current flare^a	Recent treatment	Outcome	SARS-CoV-2 infection status
Case 1	88/M/W/BP/Pfizer	24 h (dose 2)	ELISA (2020): BP180, negative; BP230 15.8 units	Prednisone 5–10 mg daily, triamcinolone 0.1% cream	ELISA: BP180, negative; BP230 10 units IIF: 1:10, 240 BMZ IgG (ME), 1:2,560 (roof, HSS)	Prednisone 40 mg daily taper	Baseline by 5 weeks	Negative
Case 2	69/M/W/BP/Moderna	14 days (dose 2)	IIF (2019): > 1:40,960 BMZ IgG (ME), 1:10,240 (roof, HSS) ELISA (2019); BP180, 15 units; BP230, 63 units	None (prior cyclosporine; on adalimumab for psoriasis)	Not available	Augmented betamethasone 0.05% ointment	Resolved by 6 weeks	Positive (confirmed by SARS-CoV-2 PCR 4 months prior to vaccination)
Case 3	50/F/W/PF/Pfizer	7 days (dose 1)	IIF (2019): > 1:40 cell surface IgG4 (ME and IHS) ELISA (2019): Dsg-1, 84 units	None (prior prednisone and rituximab, last administered June 2019)	IIF: negative (ME), 1:10 cell surface IgG4 (IHS) ELISA: Dsg-1, 23 units	Prednisone 10 mg daily taper, augmented betamethasone 0.05% ointment	Baseline by 10 weeks	Negative

ABD, autoimmune bullous disorders; BMZ, basement membrane zone; BP, bullous pemphigoid; Dsg-1, desmoglein-1; ELISA, enzyme-linked immunosorbent assay; F, female; IHS, intact human skin; IIF, indirect immunofluorescence; HSS, human split skin; M, male; ME, monkey esophagus; Moderna, Moderna mRNA-1273 COVID-19 vaccine; PCR, polymerase chain reaction; Pfizer, Pfizer-BioNTech BNT162b2 mRNA COVID-19 vaccine; W, white
^aReference ranges: IIF: positive: > 1:10 (ME, IHS, HSS); borderline/indeterminate: 1:10 BMZ IgG (ME, HSS), 1:10 cell surface IgG4 (ME and IHS); negative: < 1:10 (ME, HIS, HSS); ELISA: BP180 and BP230: > 9 units; Dsg-1: > 20 units; borderline/indeterminate: Dsg-1: 9-20 units; negative: Dsg-1: < 9 units.

ISSN: 1752-1947