Bullous Pemphigoid Suspected to Be Caused by COVID-19 Vaccine: A Case Report

Abstract

Introduction: Bullous pemphigoid (BP) is the most common autoimmune subepidermal blistering disease, caused by autoantibodies against the hemidesmosomal proteins BP180 and BP230. Although usually idiopathic, BP has increasingly been reported following COVID-19 vaccination, and early recognition of this association is clinically important.

Case Description: A 64-year-old man developed widespread tense bullae over erythematous skin with pruritus and pain, sparing the face, two days after the first dose of an inactivated (Sinovac) COVID-19 vaccine. He had no history of drug or food allergy, prior skin disease, or relevant comorbidity. Dermatological examination revealed multiple tense bullae with papular and vesicular lesions over erythematous macules and plaques on the extremities and trunk, with erosions, excoriations, and crusts; Nikolsky’s sign was negative. Histopathology demonstrated subepidermal bullae with acanthosis and an inflammatory infiltrate rich in eosinophils, lymphocytes, and neutrophils, confirming BP suspected to be vaccine-induced. The patient was treated with systemic and topical corticosteroids together with an oral antibiotic, antihistamine, and supportive care. After one week, the lesions improved markedly with no new bullae, and corticosteroids were gradually tapered.

Conclusion: Bullous pemphigoid may develop shortly after COVID-19 vaccination. Although a causal relationship cannot be firmly established, clinicians should remain aware of this potential association, particularly in elderly patients presenting with new-onset blistering eruptions after vaccination, as early recognition enables prompt management and a favorable outcome.

Keywords: Autoimmune Blistering Disease, Bullous Pemphigoid, COVID-19 Vaccine, Cutaneous Adverse Reaction, Pemphigoid