"Toxic erythema" and eosinophilia associated to tocilizumab therapy in a COVID-19 patient

Since the new fatal pneumonia was identified in December 2019 in Wuhan, China, the WHO declared the infection a health emergency of international concern. The novel ss-RNA ß-coronavirus (SARS-CoV-2) spreads through airborne and direct contagion; virulence is high in the elderly and in patients with diabetes, chronic pulmonary, cardiovascular and neoplastic diseases. SARS-CoV-2 ssRNA is recognized by intracellular Pattern Recognition Receptors (PRRs), which trigger NF-kB - the master regulator of inflammation - and Interferon Regulatory Factors (IRFs)1

Cutaneous adverse reactions after COVID-19 vaccines in a cohort of 2740 italian subjects. an observational study

An in-depth characterization of the incidence, morphology, and onset of COVID-19-vaccines cutaneous adverse reactions is currently lacking. The existing literature on COVID-19 vaccination-related cutaneous adverse reactions largely focused on messenger RNA vaccines and mainly included type 1 hypersensitivity reactions, such as urticaria and angioedema. Other cutaneous manifestations are still poorly characterized and have been classified as delayed hypersensitivity rash. Our prospective observational study on a sample of 2740 subjects who underwent the COVID-19 vaccination aimed at defining the prevalence of cutaneous adverse reactions and at identifying their timing of onset and their correlation with the administered dose. Vaccine-related cutaneous adverse reactions occurred in 50 subjects. Patients were asked to complete a questionnaire on the type of COVID-19 vaccine received, the time of onset of cutaneous reactions, and the dates of administration. Out of 2740 individuals who received the COVID-19 vaccination, 50 were diagnosed with cutaneous adverse reactions to vaccine, after the first dose in 28 patients, after the second in 20, and after both in two. We reported localized injection site erythema in 12 patients and generalized cutaneous reactions in 38 patients. Our study shows that cutaneous adverse reactions to COVID-19 vaccination are not common and most often occur after the first dose, recurring infrequently after the second dose. These reactions are usually easily manageable and, even in severe generalized cases, oral antihistamines and corticosteroids were sufficient for resolution. Therefore, except for immediate hypersensitivity reactions, cutaneous adverse reactions do not represent a contraindication to the completion of the vaccination cycle

COVID-19. important updates and developments edited by franco rongioletti, MD, and leonard hoenig, MD Impact of COVID-19 on patients with atopic dermatitis

Data on the tolerability and response to biologic therapies for type 2 immune disorders in the context of coronavirus disease 2019 (COVID-19) are currently lacking. Our survey aimed at assessing the adherence of patients to dupilumab therapy and the risk of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. A total of 80 patients with atopic dermatitis treated with dupilumab completed a web-based survey. Of the 80 patients, 7 discontinued dupilumab owing to concerns and difficulties related to COVID-19. Our sample was highly susceptible to viral infection owing to the frequency of risk factors including living in high SARS-CoV-2 burden areas, such as in Northern Italy; having comorbidities, such as asthma, diabetes, and cardiovascular disease; and being of advanced age. Older patients in our sample are particularly exposed to the risk of COVID-19–related cytokine storm, triggered by excessive interleukin-4 production and type 2 immune response. One patient contracted SARS-CoV-2 infection without the progression of COVID-19 despite continuing scheduled dupilumab treatment. Because evidence on the appropriate management of biologic therapy in the setting of COVID-19 is lacking, the collection of clinical data from patients in treatment with dupilumab is a valuable addition to current clinical practice. Our survey provides a contribution to the understanding of the tolerability and response to dupilumab during COVID-19 and suggests a feasible and effective approach to patients being treated with biologics even when social distancing is required

Eosinophilic panniculitis triggered by arthropod bites in chronic lymphocytic leukemia

Skin findings are common among patients with hematological malignancies and are thought to be expressions of a reactive spectrum peculiar to immunosuppressed patients with an unclear pathogenesis. Eosinophilic panniculitis is a reaction pattern defined by single or multiple lesions consisting in nodules and plaques, and sometimes in papules and pustules, characteristically associated to hematological neoplasms or to a series of benign conditions such as arthropod bites. We report a case of eosinophilic panniculitis occurring in a 77-year-old woman with chronic lymphocytic leukemia. Our case is remarkable as the histology of panniculitis was associated with a clinical evidence of dermal papules and a history of insect bites

Lymphomatoid drug reaction developed after BNT162b2 (Comirnaty) COVID-19 vaccine manifesting as pityriasis lichenoides et varioliformis acuta-like eruption

The current global healthcare response to the COVID-19 pandemic is focused on a widespread vaccination campaign, which started with the authorization of Pfizer/BioNTech and Moderna mRNA COVID-19 vaccines in December 2020. Local injection site reactions have been described during the clinical trials of both the abovementioned mRNA vaccines; skin rashes were additionally reported in the trial of Moderna. Despite this, cutaneous adverse reactions to the vaccines and their timing remain to date poorly characterized

Land for peace: can territorial adjustments bring about recognition of self-determination claims?

First published online: 09 July 2020De facto states represent an anomalous sovereign condition. Their parent states are unable to regain control over the territory that de facto states possess, while the de facto states are unable to secure widespread recognition of their self-determination claims without the consent of their parent states. Kosovo and Serbia have recently entertained the idea of making territorial adjustments through which a settlement between the two parties can be reached. Regardless of whether or not such an agreement will be achieved, this paper probes if and the extent to which agreements for territorial adjustments can end the anomalous sovereign condition of de facto states. To do so, it develops a novel analytical framework, employs two case studies, and analyses how crucial and supplementary conditions may jointly interact to (dis)allow possible 'land for peace' agreements. The paper finds that the likelihood of territorial compromises remains low because the peaceful reconciliation does not outweigh the tangible and intangible values of the territory