Fig. 11.

The patient was a 27-year-old woman with a history of mixed connective tissue disease received the Pfizer vaccine on March 14, 2021, and on April 4, 2021, (case 15). The patient began to feel unwell about 2 weeks after receiving her first dose of the Pfizer vaccine, heralded by pain and swelling in many of her joints. The patient then developed a very striking vesicular pustular eruption. (A) The biopsy demonstrated a very striking necrotizing neutrophilic and granulomatous folliculitis. (B) Extensive infiltration of the outer root sheath epithelium by a mixed inflammatory cell infiltrate with disruption of the wall and adjacent perifollicular inflammation with accentuation around vessels is visible. (C) A significant component of the infiltrate is lymphocytic and granulomatous in nature.