Sir,

The pandemic triggered by the coronavirus (COVID-19) has had an unprecedented impact on global health and economic growth. Multiple public health measures have been introduced to contain the spread, including vaccination. Numerous cutaneous adverse events have been reported with the various vaccines available, the majority of which are mild and do not contraindicate vaccination. Herein, we report the case of a patient who presented with a chronic acral herpes infection after COVID-19 vaccination by Sinopharm.

A 36-year-old patient, previously healthy, received his first dose of COVID-19 Sinopharm vaccination in April 2022. One month later, before receiving the second dose, he presented an acral vesicular rash with nail involvement. Dermocorticoids and oral antibiotics were prescribed without any improvement, and the evolution was marked by the occurrence of several successive flares.

Clinical examination in our department three months after the onset of the symptoms revealed grouped vesicles on an erythematous base, erosions, and crusts, located on the palmar-plantar surfaces, associated with nail involvement represented by an onychomadesis (Figs. 1a and 1b). A skin biopsy was taken, and histology revealed acanthosis with the presence of intraepidermal vesiculo-bullous structures with numerous squamous cells containing intranuclear herpetic inclusions (Fig. 2).

	Figure 1: a) Onychomadesis. b) Grouped vesicles on an erythematous base, erosions, and crusts.
	Figure 2: Intraepidermal vesiculo-bullous structures with numerous squamous cells containing intranuclear herpetic inclusions.

Treatment with valaciclovir was initiated; 1 gram per day for 10 days, and the evolution was marked by a complete regression of the lesions. A four-month follow-up showed good nail regrowth (Figs. 3a and 3b).

Figure 3: Four-month follow-up showing a) good nail regrowth and b) disappearance of the rash.

Adverse skin reactions to COVID-19 vaccines are increasingly common after the large vaccination campaigns instituted since December 2020. BBIBP-CorV is an inactivated COVID-19 vaccine developed by the Chinese laboratory Sinopharm. An Egyptian study of 4,560 patients evaluated skin adverse events related to the Sinopharm vaccine, and 26.1% of these patients experienced cutaneous side effects after an average of 2.92 days, the most common were injection site induration, urticaria, maculopapular rash, and worsening of the pre-existing dermatosis. No herpetic infections were reported in this series [1]. In addition, an Iranian case of diffuse herpetic infection in a patient with rheumatoid arthritis seven days after receiving the second dose of the Sinopharm vaccine was reported. The course was favorable after treatment with aciclovir [2].

We report this case of a young immunocompetent patient who presented one month after his first dose of the Sinopharm vaccine a chronic acral herpetic infection with nail involvement and completely resolved after treatment with valaciclovir.

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