INTRODUCTION

Although inflammatory diseases, such as female menstrual dysfunctions or myocarditis in young people, were undoubtedly recognized as adverse effects of COVID-19 vaccines shortly after the wide use of these vaccines, there are now growing signals about possible cancer reactivation [1]. In this case of malignant transformation of mycoses fungoides, we analyze the arguments for attributing this evolution to the COVID-19 vaccines in resonance with other cases that we have observed in our recent practice.

CASE REPORT

A 71-year old patient was referred to our office for a biopsy of a cutaneous lesion on the posterior surface of the right arm. He had no noticeable medical history except a squamous skin lesion of the left flank that he had observed many years before. He also had multiple erythematous cutaneous lesions of the back evoking mycosis fungoides. No axillary node was palpated. He had received a five-shot COVID-19 vaccine course; he could not provide the exact details, yet the last injection was a mRNA vaccine (Comirnaty®) seven months before. The blood test showed no major abnormality except elevated monocytosis at 1.02 G/L (15.4%). The original lesion included two asymmetrical erythematous spots with ulceration of the main lesion measuring approx. 8–9 mm (Fig. 1a). An appointment for surgery was given to the patient fifteen days later. Meanwhile, the lesion had been rapidly growing with the confluence of the two lesions, elevation of the margins, and deep central erosion (Fig. 1b). Surgery was undertaken under local anesthesia. The tumor measuring 30 x 40 mm was completely resected and the histologic result concluded to T lymphoproliferation with high CD30+ cells. Five days later, he developed a Staphylococcus aureus infection (Fig. 1c), which led to complete relapse of the scar. A PET/CT scan showed no lymph node involvement. He was treated by his general practitioner with a course of injectable Rocephine® (ceftriaxone). The lesion finally healed after sixty days, yet remained inflammatory (Fig. 1d). A treatment with methotrexate (one 15 mg tablet every week) has been introduced and is planned to last eight weeks.

Figure 1: (a) Original lesion of the left arm. (b) Natural evolution of the lesion fifteen days before surgery. (c) Post-operative infection on day 5. (d) Complete healing after four months.

DISCUSSION

The dermatologic side-effects after COVID-19 vaccination have already been described [2,3], yet they were usually limited in time and, thus, have not raised serious concerns. However, the occurrence of primary lymphomas after COVID-19 vaccination, although scarce, is more worrying [4–6]. These T-cell lymphomas have been observed in patients having one to three doses of the Comirnaty® mRNA vaccine with an onset of the lesion varying from 1–15 days [4,5] to 6 months, respectively [4]. Worsening of a pre-existent comorbidity after COVID-19 vaccination must also be taken in consideration and has been described with inflammatory cutaneous disease (psoriasis) [7], yet more alarming is the recurrence of a tumoral pathology [8]. In our case, we could establish a formal link of this pathology with the COVID-19 vaccination as the onset of the lesion is long (several months), yet this hypothesis is plausible as the incidence of this pathology is low (6.4 per million persons) [9]. We were mainly surprised by the rapid growth of the lesion. Hopefully, the number of reports of T-cell lymphomas after COVID-19 vaccines in the medical literature remains low (24 cases in 12 publications) [9], and most cases seem to react favorably to the medical treatment [10]. It is also possible that they are linked to a predisposed genetic condition [6]. Until now, in our daily practice, we have not observed an augmentation in the incidence of common skin cancers that is growing mainly because of the aging of the population. However, a rising occurrence of atypic cancer forms would constitute an alarming signal and should be carefully scrutinized. This would question the dogma of the mandatory COVID-19 vaccination of patients with a pre-existing cancer. This case also teaches us that a careful survey of the COVID-19 vaccines will be needed for a long, if unlimited, time, more particularly with patients having a lymphoproliferative disease [11]. A response to medical treatment will also be a matter of concern in the future.

REFERENCES

1. Olszewska B, Zaryczańska A, Nowicki RJ, Sokołowska-Wojdyło M.Rare COVID-19 vaccine side effects got lost in the shuffle. Primary cutaneous lymphomas following COVID-19 vaccination:A systematic review. Front Med (Lausanne). 2024;11:1325478.

2. Kaderi K, Golezar MH, Mardani A, Mallah MA, Moradi B, Kavoussi H, et al. Dermatol Ther. 2022;35:15391.

3. Dupoirieux L. Zoster eruption in COVID-19 multiple-shot vaccinated patients:A report of two cases. Our Dermatol Online. 2023;14:396-8.

4. Goldman S, Bron D, Tousseyn T, Vierasu I, Dewispelaere L, Heimann P, et al. Rapid progression of angioimmunoblastic T Cell lymphoma following BNT162b2 mRNA vaccine booster shot:A case report. Front Med (Lausanne). 2021;8:798095.

5. Cavanna, L, Grassi, SO, Ruffini L, Michieletti E, Carella E, Palli D, et al. Non-Hodgkin lymphoma developed shortly after mRNA COVID-19 vaccination:Report of a case and review of the Literature. Medicina (Kaunas). 2023;59:157.

6. Khatri JK, Tahboub I, Anwar K, Masoudi M, Graffeo V, Jamil MO. Diagnosis of angioimmunoblastic T Cell lymphoma after receiving first dose of Pfizer/BioNTech (BNT162b2) Vaccine:A case report. J Investig Med High Impact Case Rep. 2024;12:1-4.

7. Boubnane I, Faras S, Aboudourib M, Hocar O, Amal S. Psoriasis worsening related to COVID-19 vaccination:A single-center report. Our Dermatol Online. 2023;14:230-3.

8. Panou E, Nikolaou V, Marinos L, Kallambou S, Sidiropoulou P, Gerochristou M, et al. Recurrence of cutaneous T-cell lymphoma post viral vector COVID-19 vaccination. J Eur Acad Dermatol Venereol. 2022;36:91-3.

9. Hristov AC, Tejasvi T, Wilcox RA. Cutaneous T-cell lymphomas:2023 update on diagnosis, risk-stratification, and management. Am J Hematol. 2023;98:193?209.

10. Gordon ER, Adeuyan O, Kwinta BD, Schreidah CM, Fahmy LM, Queen D, et al. Exploring cutaneous lymphoproliferative disorders in the wake of COVID?19 vaccination Skin Health Dis. 2024;4:367.

11. Goldman, M. The safety of Anti-SARS-CoV-2 Vaccines:Vigilance is still required. J. Clin. Med. 2022;11:1248.