‘Alarming’ Increase in ‘Rare’ & ‘Potentially Fatal Skin Disorder’ Potentially Linked to COVID-19 Jabs

Researchers have found an ‘alarming’ seven-fold increase in Stevens-Johnson syndrome (SJS), a rare and potentially fatal skin disorder.

SJS, also known as toxic epidermal necrolysis (TEN), “is a rare, acute, serious, and potentially fatal skin reaction in which there are sheet-like skin and mucosal loss accompanied by systemic symptoms,” according to the NIH.

From the NIH:

Stevens-Johnson syndrome/toxic epidermal necrolysis is classified by the extent of the detached skin surface area.

• Stevens-Johnson syndrome: less than 10% body surface area
• Overlap Stevens-Johnson syndrome/toxic epidermal necrolysis: 10% to 30% body surface area
• Toxic epidermal necrolysis more than 30% body surface area

“There appears to be an association between toxic epidermal necrolysis / Steven’s Johnson syndrome and COVID and the vaccine,” according to a case series published by Burns. 

'Alarming' Sevenfold Increase In Stevens-Johnson Syndrome Linked To COVID-19 And Vaccine https://t.co/CwuFU2PCMv

— zerohedge (@zerohedge) July 10, 2023

From Burns:

Stevens-Johnson syndrome (SJS) / toxic epidermal necrolysis (TEN) is a rare, potentially life threatening mucocutaneous hypersensitivity reaction resulting in desquamation of the skin and mucosa. These patients are managed on burns units due to the widespread desquamation. We report the largest case series of participants developing SJS/TEN in the setting of recent COVID infection or vaccination. We found a seven-fold increase in SJS/TEN since the COVID pandemic. This increase correlates with an increase in COVID infections and vaccination rates. We explore the immunopathological relationships between COVID and SJS/TEN and propose theories for possible associations.

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A sudden increase in Stevens-Johnson syndrome (SJS)—a rare and potentially fatal skin disorder—may be triggered by COVID-19, increased vaccination rates, or a lowered threshold caused by vaccines or previous infection, according to a large case series recently published pic.twitter.com/Oe9LrVYLe0

— DiedSuddenly (@DiedSuddenly01) July 10, 2023

Cont. from Burns:

In 2022, our institution saw a sharp rise in SJS/TEN presentations. As a state-wide burns unit and referral centre for SJS/TEN, our institution manages two to four cases per year, prior to COVID. In the first six months of 2022 however, we managed fourteen cases. Five of these cases had COVID in the preceding month. Three of the fourteen had a COVID vaccine in the preceding month. All fourteen cases received a COVID vaccine.

We present a case series of eight patients diagnosed with COVID or having received the vaccine in the preceding month. All data collected was de-identifiable with all authors having access. Ethics approval was not required due to negligible risk. No funding was required with no conflicts of interest to declare.

“A 60-year-old female admitted with 55 % TBSA TEN (Fig. 1). COVID infection six weeks prior to onset. Received allopurinol for exacerbation of gout. Has previously taken allopurinol with no adverse effect. She was double vaccinated with a mRNA vaccine,” Case 1 reports.

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*Source – ScienceDirect*

“A 78-year-old female admitted with 60 % TBSA TEN. COVID five weeks prior to onset. Developed COVID associated pneumonitis and received piperacillin/tazobactam. She was double vaccinated with a mRNA vaccine,” Case 2 reports.

“A 54-year-old female admitted with 40 % TBSA TEN. COVID four weeks prior to onset. Developed COVID associated pneumonitis secondary to aspergillus. Received voriconazole. She was double vaccinated with a mRNA vaccine,” Case 3 reports.

“A 26-year-old male admitted with 70 % TBSA TEN. Received a mRNA vaccine three weeks prior to onset. Due to vaccine associated symptoms, he took paracetamol and ibuprofen. He has previously taken paracetamol and ibuprofen with no adverse effect. He was triple vaccinated with previous two doses of a viral vector vaccine,” Case 4 reports.

“A 45-year-old-male admitted with 70 % TBSA TEN. COVID infection four weeks prior to onset. Received levetiracetam for seizure prophylaxis post a traumatic subarachnoid haemorrhage. He was triple vaccinated with a mRNA vaccine,” Case 5 reports.

“A 53-year-old-female admitted with 95 % TBSA TEN. Received a viral vector vaccine three weeks prior to onset. Quadruple vaccinated with previous doses of both viral vector and mRNA vaccines. Received captopril and amlodipine for scleroderma renal crisis,” Case 6 reports.

“A 47-year-old male admitted with 10 % TBSA SJS/TEN overlap. COVID infection five weeks prior to onset. Received amoxycillin four weeks prior. Has previously taken amoxycillin with no adverse effect. Triple vaccinated with mRNA vaccine,” Case 7 reports.

“A 53-year-old female admitted with 90 % TBSA TEN. Received a mRNA vaccine four weeks prior to onset. Triple vaccinated with mRNA vaccine. Received piperacillin/tazobactam for bacterial peritonitis. Has previously taken penicillins with no adverse effects,” Case 8 reports.

COVID Advisor reports:

Of the 14 reported cases, five patients had COVID-19 a month before developing SJS/TEN, and three of 14 patients received a COVID-19 vaccine one month prior. Not a single case of SJS/TEN was reported in an unvaccinated individual.

Researchers said the rarity of the condition and presence of medications known to trigger the disease make the link difficult to prove, but the rapid rise in cases since the beginning of the pandemic and vaccine rollout is “alarming.”

SJS/TEN is a severe hypersensitivity condition where the skin develops rashes, blisters, and peels forming painful areas that resemble a severe hot water burn. Mucous membranes, including the eyes, genitalia, and mouth, are often affected or severely damaged, leading to sepsis, pneumonia, infection, or death.

Although SJS and TEN were once considered separate conditions, they are now part of the same disease—with SJS representing the less severe end of the disease spectrum and TEN representing the most severe.

Medications, including epilepsy medicines, antibiotics, and anti-inflammatory painkillers, are the chief cause of SJS/TEN, but certain viruses and vaccines can also cause the condition. Due to its potentially fatal nature, SJS/TEN is considered a medical emergency, and patients are treated in burn units.

The researchers proposed three theories for the alarming increase in SJS/TEN.

From Burns:

6. Virus induced

The SARS-COV-2 virus may directly bind to receptors that trigger a T cell mediated response and subsequently SJS/TEN. Many viruses have already been implicated in the development of SJS/TENS including herpes simplex virus, Epstein-Barr virus (EBV), cytomegalovirus and influenza [13]. Their viral proteins bind to the major histocompatibility (MHC) complex I on the antigen presenting cell triggering activation of cytotoxic T cells. This T cell mediated response may subsequently result in SJS/TEN. Five cases of COVID infection preceding SJS/TEN have been reported in the literature [14], [15], [16], [17], [18]. The average time of onset from diagnosis was 3 weeks (range: 1 – 5 weeks). This is consistent with our cases with an average of 5 weeks (range: 4 – 6 weeks).

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7. Vaccine induced

The vaccine may directly bind to receptors to trigger SJS/TEN. Many drugs, like viruses, have been implicated as triggers. It is recognised that drugs bind MHC class I to trigger a cytotoxic T cell response [5]. A recent study found the ChAdOx1 nCoV-19 adenoviral vector vaccine induces T helper type 1 cells leading to clonal expansion of cytotoxic T cells and subsequent protection against severe COVID infection [19]. This T cell response can also induce the granule mediated pathway of perforin, granulysin and granzyme B release to cause keratinocyte apoptosis seen in SJS/TEN. This response peaks between seven- and 28-days post vaccination [19]. This time peak is consistent with our cases. Eight case reports have been identified in the literature describing SJS/TEN post-COVID vaccine. Four of these cases were associated with mRNA vaccines, three with viral vector vaccines and one with whole virus vaccines. In our case series, two patients received a mRNA vaccine and one a viral vector in the preceding month to their presentation.

8. Threshold lowering

The SARS-COV-2 virus or vaccine may lower the threshold for a drug to trigger SJS/TEN. We hypothesise that the virus or vaccine “primes” the immune system for a drug to cause SJS/TEN, which may not have done so without this “priming”. Infectious mononucleosis caused by EBV has this “priming” effect to induce a drug induced hypersensitivity (DiHS) reaction when an individual is exposed to penicillin. This DiHS manifests as a generalised rash. The large expansions of activated EBV-specific cytotoxic T cells and increased natural killer (NK) cell numbers are observed during the disease [20] and EBV-specific T cells have been shown to cross-react with self-human leukocyte antigen alleles [21], [22]. The development of a drug rash during infectious mononucleosis may be due to cross reactivity between penicillins and the expansion of EBV- specific cytotoxic T cells already present prior to giving the drug.