Abstract Background The reactivation of herpesviruses (HHV) in COVID-19 patients is evident in the literature. Several reports have been published regarding the reactivation of these viruses (HSV, VZV, EBV, and CMV) among those who got COVID-19 vaccines. In this study, we aimed to review the current evidence to assess whether HHVs reactivation has any association with the prior administration of COVID-19 vaccines. Methods A systematic search was conducted on 25 September 2022 in PubMed/MEDLINE, Web of Science, and EMBASE. We included all observational studies, case reports, and case series which reported the reactivation of human herpesviruses following administration of COVID-19 vaccines. Results Our systematic search showed 80 articles that meet the eligibility criteria. Among the evaluated COVID-19 vaccines, most of the vaccines were mRNA based. Evidence from observational studies showed the possible relation between COVID-19 vaccine administration and VZV and HSV reactivation. The results of our proportion meta-analysis showed that the rate of VZV reactivation among those who received the COVID-19 vaccine was 14 persons per 1000 vaccinations (95% CI 2.97–32.80). Moreover, our meta-analysis for HSV reactivation showed the rate of 16 persons per 1000 vaccinations (95% CI 1.06–46.4). Furthermore, the evidence from case reports/series showed 149 cases of HHV reactivation. There were several vaccines that caused reactivation including BNT162b2 mRNA or Pfizer–BioNTech ( n = 76), Oxford-AstraZeneca ( n = 22), mRNA-1273 or Moderna ( n = 17), Sinovac ( n = 4), BBIBP-CorV or Sinopharm ( n = 3), Covaxin ( n = 3), Covishield ( n = 3), and Johnson and Johnson ( n = 1). Reactivated HHVs included varicella-zoster virus (VZV) ( n = 114), cytomegalovirus (CMV) ( n = 15), herpes simplex virus (HSV) ( n = 14), Epstein-Barr virus (EBV) ( n = 6), and HHV-6 ( n = 2). Most cases reported their disease after the first dose of the vaccine. Many patients reported having comorbidities, of which hypertension, diabetes mellitus, dyslipidemia, chicken pox, and atrial fibrillation were common. Conclusion In conclusion, our study showed the possible association between COVID-19 vaccination and herpesvirus reactivation. The evidence for VZV and HSV was supported by observational studies. However, regarding other herpesviruses (EBV and CMV), further research especially from observational studies and clinical trials is required to elucidate the interaction between COVID-19 vaccination and their reactivation. 

Herpesviruses reactivation following COVID-19 vaccination: a systematic review and meta-analysis

Melanoma is among the most aggressive tumors, with different histological patterns of presentation ranging from the usual and easily diagnosable pictures to complex patterns of difficult diagnostic interpretation. Here, we present three cases of a very rare melanoma variant described as "carcinoid-like" and "paraganglioma-like" in the literature, and a brief review of the current literature of the very few cases described to date.

https://www.mdpi.com/2296-3529/8/2/19/pdf

The Great Mime: Three Cases of Melanoma with Carcinoid-Like and Paraganglioma-Like Pattern with Emphasis on Differential Diagnosis.

Cutaneous perivascular epithelioid cell tumors (PEComas) are peculiar, rare mesenchymal tumors of uncertain lineage. They show a characteristic epithelioid morphology, and they are usually composed of monomorphous clear-to-granular appearing perivascular cells. One of the main differential diagnoses with PEComas is a cutaneous metastasis from renal cell carcinoma (RCC). CD10 has been emphasized to be a crucial marker in the diagnosis of metastasis from RCC. Although visceral PEComas have been studied for CD10 expression, primary cutaneous PEComas have not. Although it could be assumed a priori that cutaneous PEComas would stain as their visceral counterpart, there is increasing evidence that cutaneous PEComas could actually be unrelated to PEComas from other organs. In this report, the author's studied three primary cutaneous PEComas, and included CD10 in our immunohistochemical studies. All three PEComas expressed the marker. They conclude that a CD10 clear-cell dermal tumor is not necessarily equivalent to a metastasis from RCC and that additional stains should be added to rule out PEComa, even if the biopsy or the panel of antibodies is limited.

Cutaneous Pecomas Express Cd10: Implications for the Classification of Pecomas and the Differential Diagnosis With Metastatic Renal Cell Carcinoma.

Indian data regarding serious neurological and psychiatric adverse events, following coronavirus disease 2019 (COVID-19) vaccination, are lacking. We, therefore, systematically evaluated cases of post-vaccinal serious neurological and psychiatric adverse reactions published from India. A systematic review of cases published from India, which were archived in PubMed, Scopus, and Google Scholar databases, was performed; pre-print databases along with ahead-of-print contents were searched in addition. Retrieved articles, as on June 27, 2022, were evaluated following PRISMA guidelines. EndNote 20 web tool was used to make a PRISMA flow chart. Individual patients' data were compiled in a tabular form. The protocol of the systematic review was registered with PROSPERO (CRD42022324183). A total of 64 records describing 136 instances of serious neurological and psychiatric adverse events were identified. More than 50% (36/64) reports were from the following four states, namely, Kerala, Uttar Pradesh, New Delhi, and West Bengal. The mean age of persons developing these complications was 44.89 ± 15.77 years. In the majority, adverse events occurred within 2 weeks of administration of the first dose of COVISHIELD vaccine. Immune-mediated central nervous system (CNS) disorders were identified in 54 instances. Guillain-Barre syndrome and other immune-mediated peripheral neuropathies were reported in 21 cases. Post-vaccinal herpes zoster was recorded in 31 vaccine recipients. Psychiatric adverse events were recorded in six patients. In Indian recipients of COVID-19 vaccine, a variety of serious neurological complications were reported. The overall risk appears minuscule. Immune-mediated central and peripheral neuronal demyelinations were the most frequently reported post-vaccinal adverse events. A large number of cases of herpes zoster have also been reported. Immune-mediated disorders responded well to immunotherapy.

Spectrum of Serious Neurological and Psychiatric Adverse Events in Indian COVID-19 Vaccine Recipients: A Systematic Review of Case Reports and Case Series

Botulinum toxin and hyaluronic acid injections are commonly used in plastic surgery. However, these treatment methods can also cause adverse events. This article reports a case of herpes zoster that occurred several days after botulinum toxin and hyaluronic acid injections. Antiviral treatment of herpes zoster virus proved successful in managing this complication. Furthermore, several articles concerning injection therapy-induced herpes zoster are reviewed. It is suggested that clinicians should consider herpes zoster in the differential diagnosis of unilateral erythema and papules, following injection therapy, in order to provide timely treatment. 

Herpes Zoster after Botulinum Toxin Combined with Hyaluronic Acid Injection

Paraganglioma-like dermal melanocytic tumor (PDMT) is a rare subtype of benign dermal melanocytic tumor, first described in 2004. Its histopathologic features resemble those of paraganglioma, showing presence of a distinctive partitioning of the tumor into small and large packets, nests, or short cords by delicate fibrous septa (zellballen pattern). But the immunostaining characteristics are those of melanocytic lesions, as PDMT express S-100, melan A, HMB 45 and lack pancytokeratin markers. It has a benign course, although a lesion of low malignant potential cannot be excluded. We describe a case of 60-year-old female who presented with three PDMT lesions on her right leg. To the best of our knowledge this is the first case reported from India.

Paraganglioma-like dermal melanocytic tumor

Context: Epidemiological data demonstrate that psoriasis patients suffer from a spectrum of co-morbidities such as cardiovascular disorders and metabolic syndrome (MS).
Aims: To compare the prevalence of metabolic syndrome and its individual components in psoriatic patients to that of the control population. Also to compare the descriptive characteristics of psoriasis in patients with and without the metabolic syndrome.
Settings and Design: Cross-sectional study.
Methods and Material: 51 patients with a clinical diagnosis of chronic plaque psoriasis were taken for the study. Metabolic syndrome was identified with the National Cholesterol Education Program’s Adult Treatment Panel III guidelines.
Statistical analysis used: Statistical Package for the Social Sciences {SPSS} version 13 software, Chi square test and Student’s t test were used where appropriate.
Results: MS was found in 21(41.2%) of the psoriatic patients compared to only 16 (31.4%) of non-psoriatic controls in our study. Psoriatic patients with MS had a higher mean age and later age of onset of psoriasis. There was no positive correlation of severity or duration of the disease with MS in this study, but psoriatic arthritis was found to be more in patients having metabolic syndrome. Also psoriatic patients with MS had a statistically significant higher BMI than psoriatics who had no MS.
Conclusions: MS was found to be more in psoriatic patients, even though it was not statistically significant. Psoriatic patients with MS had a higher mean age, later age of onset, higher BMI and higher prevalence of psoriatic arthritis than those without MS.

Keywords: Crosssectional study, Metabolic syndrome, Psoriasis vulgaris.

https://www.ijced.org/journal-article-file/13295

A study of the association of psoriasis with metabolic syndrome from a tertiary care centre in Kerala, South India

Background Skin prick testing (SPT) provides information about the presence of specific immunoglobulin E (IgE) to protein and peptide antigens and maybe helpful to identify the triggering food items in chronic urticaria. Objective The aim of this study was to determine the prevalence of food allergy among chronic urticaria patients, by doing SPT with commercially available 20 food allergens. Patients and methods All consecutive patients with recurrent urticarial wheals of more than 6 weeks of duration and age more than 12 years and were included. SPT was done using 20 allergens in the study patients after detailed examination. Complete blood count and total serum IgE were checked. Results In all, 62.9 % of chronic urticaria patients had positive SPT to food allergens. No statistically significant association was found between SPT results and demographic parameters, duration of disease, urticaria activity score, or serum IgE levels. In 31.46% (28) patients who had suspected food allergy, only 7 (25%) had a positive SPT result to the corresponding allergen. Conclusion SPT s may be used as a screening test to evaluate food allergy in chronic urticaria patients. The results should better be validated with specific IgE and food challenge tests.

Study of prevalence of skin prick test positivity for food allergens in chronic urticaria patients attending a tertiary care center in South India

Ever since the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, science has unraveled much knowledge on SARS-CoV-2 which has led to extraordinary and unprecedented progress in developing COVID-19 vaccines. Several adverse cutaneous reactions, ranging from more common local injection site reaction, neutrophilic and pustular drug reactions to flare-up of preexisting dermatoses, have been reported with currently available vaccines. We report a case series of 7 patients who developed herpes zoster (HZ) following the first dose of ChAdOx1 nCoV-19 coronavirus vaccine (recombinant). HZ following vaccination is a rare entity. The occurrence of HZ in the patients presented in this series within the time window 1–21 days after vaccination defined for increased risk and postulated dysregulation of T-cell-mediated immunity, suggests that the ChAdOx1 nCoV-19 coronavirus vaccine (recombinant) could probably be a trigger for reactivation of varicella zoster virus to cause HZ in them.

Herpes zoster following vaccination with ChAdOx1 nCoV-19 Coronavirus vaccine (recombinant)

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Papers

Paraganglioma-like dermal melanocytic tumor

A study of the association of psoriasis with metabolic syndrome from a tertiary care centre in Kerala, South India

Study of prevalence of skin prick test positivity for food allergens in chronic urticaria patients attending a tertiary care center in South India

Herpes zoster following vaccination with ChAdOx1 nCoV-19 Coronavirus vaccine (recombinant)