Two cases of facial eruption with leukocytosis with neutrophil predominance have been reported following receipt of the mRNA-1273 COVID-19 vaccine, according to a research letter published online July 28 in JAMA Dermatology.

Eric Dean Merrill, M.D., from the University of California in San Francisco, and colleagues offer details on two patients without history of known allergies, rosacea, or facial/dental fillers who presented with facial eruption that developed within 24 hours of receiving the mRNA-1273 vaccine.

The authors describe a previously healthy man in his 50s who presented four days after mRNA-1273 vaccine receipt. The patient noticed chills and facial swelling within 24 hours, which developed into painless, nonpruritic erythema. On presentation, he had a leukocytosis with neutrophil predominance and no fever. Bilateral edematous, erythematous, well-demarcated plaques of the central face and eyelids were identified. The rash cleared within seven days, and the patient received the second vaccine dose as scheduled, with no recurrence. The second patient was a previously healthy man in his 80s who presented five days after receipt of the second dose of the mRNA-1273 vaccine. The patient noticed swelling within 24 hours, with worsening swelling, pain, and erythema over the following days. He had a leukocytosis with neutrophil predominance at presentation and no fever. Erythematous, edematous plaques spanning the eyelids, cheeks, and nasal dorsum were identified on examination. The rash resolved 10 days later.

"It is unclear if this facial eruption in the setting of the mRNA-1273 vaccine represents a distinct entity or an unmasking of a dermatologic condition in a predisposed individual," the authors write.

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