COVID-19 Vaccination as a Precipitating Factor in Cutaneous Lupus Erythematosus with Lupus Nephritis: A Clinical Case Report

The advent of the COVID-19 vaccine has improved global mortality, but recent literature suggests that COVID-19 vaccinations may induce or exacerbate autoimmune rheumatic diseases. Here, we present a 64-year-old woman with a history of Evans syndrome, pernicious anemia, and positive antinuclear antibody (ANA) who developed systemic lupus erythematosus (LE) presenting with cutaneous involvement following her first Moderna COVID-19 vaccine dose. She presented with a pruritic rash, malaise, and paresthesia ten days after vaccination. Clinical examination revealed erythematous, scaly, annular plaques on her face, ears, upper extremities, and chest, hand edema, and a palatal erosion. Laboratory findings included an elevated ANA titer (1:640), positive anti-RNP and anti-Ro antibodies, hematuria and proteinuria. This contrasted with previous laboratory results from 2019, where her ANA titer was higher at 1:2560, with anti-RNP elevated at 358 and anti-Ro at 252. Skin biopsy confirmed cutaneous LE and renal biopsy confirmed membranous lupus nephritis. Treatment included hydroxychloroquine, mycophenolate mofetil, prednisone, clobetasol ointment, and triamcinolone ointment, with subsequent improvement. Although rare, COVID-19 vaccination should be considered as a potential trigger for LE, particularly in patients with predisposition to autoimmune disease. Vaccination against COVID-19 should still be encouraged among patients with autoimmune rheumatic diseases, preferably during remission and before the initiation of disease-modifying antirheumatic drugs.