A 76-year-old, female patient presented with worsening edema and pruritus in both lower legs which began three days after her second COMIRNATYⓇ injection and continued for 13 days thereafter. She had no history of any allergic disease, including allergic reactions to polyethylene glycol, or urticaria, except for a single episode of a drug rash caused by cephalosporin over 40 years previously. Physical examination revealed non-pitting edema and erythema on both lower legs (Picture 1). No other abnormalities were observed, including at the injection site. The laboratory findings were normal except for elevated eosinophils (960 /μL). A skin biopsy revealed edema from the dermis to subcutaneous tissue and eosinophilic infiltration between the collagen fibers and around the blood vessels (Picture 2). No prick test was done for polyethylene glycol or COMIRNATYⓇ. All the symptoms resolved about six weeks post-onset with only oral and topical antihistamine therapy. There was no recurrence (Picture 3). Based on these findings, non-episodic angioedema with eosinophilia (NEAE) was thus diagnosed.
Picture 1.
Picture 2.
Picture 3.
NEAE usually occurs in young women, and its cause is unknown (1,2). The present case demonstrated a rare case of NEAE in an elderly patient and raised the possibility of an association with COMIRNATYⓇ use.
The authors state that they have no Conflict of Interest (COI).
References
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