Neutrophilic dermatosis with necrobiotic changes as an unusual manifestation after the first shot of a COVID-19 mRNA vaccine together with a high fever and liver injury

Coronavirus disease 19 (COVID-19) mRNA vaccines sometimes cause various skin rashes. We report an unusual case of erythema nodosum-like nodules with vesicular and pustular papules, which arose after the first shot of a COVID-19 mRNA vaccine. A skin biopsy showed marked neutrophilic infiltration with necrobiotic changes throughout the dermis and subcutis. Immunohistochemically, CD8⁺ cells were much more common than CD4⁺ cells in the dense neutrophilic infiltrates. Many CD68⁺ macrophages were present around the CD8⁺ cells. No cases of neutrophilic dermatosis with necrobiotic changes have been reported. Thus, our findings should be added to the cutaneous adverse effects of the vaccines.