Table 1.

Chronology of clinical features, laboratory results, and treatment modalities

	Day + 4, saw pediatrician and was referred to dermatologist	Day + 20, seen by pediatric dermatology	Day + 35–38, seen by pediatric rheumatology and nephrology
Clinical features	Rash (face, with spread to knees and arms)	Persistent rash, joint pains, hair loss, and light sensitivity	Arthritis bilateral elbows, also found to have palatal erythema and persistent rash
Laboratory results	+ANA (1:80), +dsDNA, +Smith, +RNP, +Ro antibodies, low complements (C3 43, C4 7)		ANA 1:1280 with confirmed Smith/RNP, dsDNA, Ro+ antibodies; urine protein: creatinine elevated to 13.5 mg/mg
Treatment	Topical steroid cream	Oral cephalexin	Mycophenolate mofetil 1000 mg twice daily; hydroxychloroquine 300 mg daily; Prednisone 60 mg’ daily; famotidine 20 mg daily

Day 0 (administration of 3rd SARS-CoV-2 Pfizer-BioNTech mRNA vaccine

Day + 4, saw pediatrician and was referred to dermatologist

Day + 20, seen by pediatric dermatology

Day + 35–38, seen by pediatric rheumatology and nephrology

Clinical features

Rash (face, with spread to knees and arms)

Persistent rash, joint pains, hair loss, and light sensitivity

Arthritis bilateral elbows, also found to have palatal erythema and persistent rash

Laboratory results

+ANA (1:80), +dsDNA, +Smith, +RNP, +Ro antibodies, low complements (C3 43, C4 7)

ANA 1:1280 with confirmed Smith/RNP, dsDNA, Ro+ antibodies; urine protein: creatinine elevated to 13.5 mg/mg

Treatment

Topical steroid cream

Oral cephalexin

Mycophenolate mofetil 1000 mg twice daily;

hydroxychloroquine 300 mg daily;

Prednisone 60 mg’ daily;

famotidine 20 mg daily

ANA antinuclear antibody, dsDNA double-stranded deoxyribonucleic acid, RNP ribonucleoprotein