Cutaneous T-cell-rich lymphoid infiltrates have been reported after Pfizer BioNTech COVID-19 vaccination, according to a research letter published online July 20 in JAMA Surgery .

Madeline J. Hooper, from the Northwestern University Feinberg School of Medicine in Chicago, and colleagues conducted a retrospective case series, including six cases of T-cell-rich cutaneous lymphoid infiltrates shortly after severe acute respiratory syndrome coronavirus 2 vaccination.

The researchers identified three male and three female patients, with a median age of 47 years. One patient had multiple sclerosis and one had a history of psoriasis and transverse myelitis. All patients received the Pfizer/BioNTech vaccine. The median time from the first dose to development of lesions was 22 days. Vaccine-related constitutional symptoms were reported by two patients, while three reported lesional pruritus. Cutaneous eruptions were characterized by single or generalized papulonodules on the trunk and/or extremities (two and four patients, respectively). T-cell-predominant lymphoid infiltrates consistent with pityriasis lichenoides et varioliformis acuta, cutaneous T-cell lymphoid hyperplasia, and lymphomatoid papulosis type A were revealed in two patients each on histologic examination. The clinical course was indolent; after various therapies, resolution was reported. After an acute viral episode, four of the patients reported recrudescence.

"Our observations should raise awareness about low-grade cutaneous lymphoid reactions after COVID-19 vaccination," the authors write.

Two authors disclosed financial ties to Kyowa Kirin, and one received a grant from Elorac.

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