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Bullous Sweet syndrome following SARS‐CoV‐2 Oxford AstraZeneca vaccine

DEAR EDITOR, A 49-year-old man with an unremarkable medical history presented with a generalized painful rash 10 days after he was given his first dose of the SARS-CoV-2 Oxford AstraZeneca vaccine. He had erythematous papules and targetoid plaques, along with haemorrhagic blisters on his hands and feet (a–d). Histopathological analysis revealed a dense perivascular, periadnexal and diffuse neutrophilic infiltrate with marked leucocytoclasia involving the upper and mid-dermis. There was massive oedema of the papillary dermis, resulting in subepidermal blistering with extravasated erythrocytes (e, f). These findings were consistent with Sweet syndrome. The patient responded well to systemic corticosteroids, thromboprophylaxis and hyperbaric oxygen therapy. We decided not to recommend the second dose of vaccine in our patient, considering a possible link between vaccination and Sweet syndrome. T. Zagar, N. Hla ca iD , I. Brajac, L. Prpi c-Massari, S. Peternel iD 1,2 and M. Ka stelan Department of Dermatovenereology, Clinical Hospital Centre Rijeka, Rijeka, Croatia; and Faculty of Medicine, University of Rijeka, Rijeka, Croatia