COVID Arm: Delayed Hypersensitivity Reactions to SARS-CoV-2 Vaccines Misdiagnosed as Cellulitis.

Journal of Primary Care & Community Health
Aleksandra L LindgrenKathleen M Welsh

Abstract

The term "COVID arm" has been coined to describe a harmless delayed hypersensitivity reaction occurring approximately a week after administration of the novel SARS-CoV-2 mRNA vaccine. It appears as a red, warm, pruritic, indurated, or swollen area in the vicinity of the vaccine site. These reactions, especially if accompanied by systemic symptoms, have been mistaken for cellulitis. We report 3 cases of COVID arm, 2 of which were mistaken for cellulitis. Distinguishing features of COVID arm from cellulitis include pruritus as a common finding, occurrence approximately a week after vaccination, a lack of progression of symptoms, rapid response to topical steroids, and/or spontaneous resolution usually over 4 to 5 days.Practice Points:• Patients receiving SARS-CoV-2 vaccines may experience delayed hypersensitivity reactions characterized by erythema, swelling, and itching occurring near the vaccination site (COVID arm), approximately a week after vaccination.• Clinicians can distinguish SARS-CoV-2 vaccine reactions from cellulitis by the time of onset (approximately a week vs 5 days), by the lack of progression of symptoms, and resolution over 4 to 5 days.• Severe cases of COVID arm may be treated with topical steroids.

References

Jan 27, 2004·Vaccine·S Michael MarcyUNKNOWN Brighton Collaboration Fever Working Group
Jan 27, 2004·Vaccine·Edward RothsteinUNKNOWN Brighton Collaboration Local Reaction Working Group
Jun 6, 2007·Vaccine·Scott HalperinUNKNOWN Brighton Collaboration Local Reaction Working Group for Cellulitis at Injection Site
Jun 8, 2007·Vaccine·Katrin S KohlUNKNOWN Brighton Collaboration Local Reactions Working Group for Induration at or near Injection Site
May 23, 2012·The Journal of Allergy and Clinical Immunology·John M KelsoDana Wallace
Jul 21, 2012·Viruses·Sandrine BelouzardGary R Whittaker
Jul 21, 2016·JAMA : the Journal of the American Medical Association·Adam B Raff, Daniela Kroshinsky
Nov 3, 2016·JAMA Dermatology·Qing Yu WengArash Mostaghimi
Feb 8, 2018·The Journal of Allergy and Clinical Immunology·Michael M McNeil, Frank DeStefano
Dec 31, 2020·The New England Journal of Medicine·Lindsey R BadenUNKNOWN COVE Study Group
Mar 4, 2021·The New England Journal of Medicine·Kimberly G BlumenthalErica S Shenoy

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