Stevens-Johnson syndrome/toxic epidermal necrolysis associated with natural thyroid medication.

Steven-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) is a rare immunologic hypersensitivity reaction to stimuli that presents as widespread eruption with mucocutaneous detachment and involvement of other organs. Multiple causes have been noted in literature, including numerous medications. In this report, we present a 52-year-old woman who arrived at the emergency department with a complaint of rash, malaise, and pruritus. She subsequently developed diffuse cutaneous and mucosal detachment. Work-up supported a diagnosis of SJS/TEN secondary to her thyroid replacement therapy, derived from desiccated pig thyroid glands. The patient's natural thyroid medication was discontinued and she responded well to appropriate treatment. This case is unique in that thyroid replacement therapy is not a commonly reported trigger of SJS/TEN. Providers should be aware of the potential for natural thyroid and other animal-derived natural medications to cause adverse reactions such as SJS/TEN.

Tratamento da resposta inflamatória tardia ao preenchimento de tecidos moles com ácido hialurônico em indivíduo imunizado Moderna após reforço com vacina Pfizer com hialuronidase / Treatment of delayed inflammatory response to hyaluronic acid soft tissue filler in a Pfizer-Boosted Moderna-Vaccinated individual with hyaluronidaseapós reforço com vacina Pfizer com hialuronidase

Apresentamos um caso de hipersensibilidade tardia ao preenchimento à base de ácido hialurônico na face após o reforço da vacina Pfizer em um indivíduo imunizado com Moderna. Este é o primeiro caso conhecido de tratamento da reação de hipersensibilidade tardia com hialuronidase após a vacinação anti-Covid. A hialuronidase é uma opção viável para tratar esta reação, particularmente para pacientes que podem não se favorecer com as opções de tratamento sistémico. Com uma quarta ronda de reforço de vacinas planejada no horizonte, pode haver um aumento da incidência de eventos adversos cutâneos, incluindo a reação discutida.

We present a case of delayed-type hypersensitivity to hyaluronic acid (HA)-based filler on the face following the Pfizer booster in a Moderna-vaccinated individual. It is the first known case of treatment of the delayed-type hypersensitivity reaction with hyaluronidase following Covid vaccination. Hyaluronidase is a viable option to treat this reaction, particularly for patients who may not benefit from systemic treatment options. With an anticipated fourth round of vaccine boosters on the horizon, there may be an increased incidence of cutaneous adverse events, including the reaction discussed.