Subacute Cutaneous Lupus Erythematosus Following COVID-19 Vaccination: A Case Report after BNT162b2 Vaccine and Literature Review

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Background: COVID-19 vaccines have demonstrated a favorable safety profile in diverse populations, including patients with autoimmune rheumatic diseases. However, rare adverse events such as disease flares and vaccine-triggered autoimmune manifestations have been reported. This study presents a case of subacute cutaneous lupus erythematosus (SCLE) following BNT162b2 vaccination and a narrative review of the literature. Methods: We describe the case of an 80-year-old woman with noninfectious aortitis who developed SCLE, annular-polycyclic type, following BNT162b2 vaccination and review published cases of SCLE after anti-SARS-CoV-2 vaccination. Results: A review of 18 published cases and 19 total, including the current case of SCLE following anti-SARS-CoV-2 vaccination, suggests that most reported patients were adult women, with and without underlying autoimmune rheumatic diseases. SCLE typically develops within days of the first vaccine dose, with most cases following mRNA-based vaccination. Conclusions: Although based on a limited number of case reports and subject to reporting bias, these findings underscore the potential for anti-SARS-CoV-2 vaccines to trigger autoimmune cutaneous reactions not exclusively in predisposed individuals, emphasizing the need for vigilance while reinforcing the overall safety and benefit of vaccination in patients with autoimmune rheumatic diseases. The incidence of SCLE following COVID-19 vaccination, and the causal relationship between vaccination and SCLE, cannot be inferred from case reports or pharmacovigilance data alone.

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