Can vaccination trigger Sweet’s syndrome?

Updated 06/09/2022.

If you’re anti-vax, this is not an anti-vax post. If you’re pro-vax, this is not an anti-vax post. Abusive comments and misinformation will not be tolerated.

Sweet’s syndrome triggered by vaccination.

Sweet’s syndrome (SS) can be triggered by vaccination, but it’s important to take the following into consideration:

• SS is rare, probably affecting no more than 3 people per 10,000 (Zamanian and Ameri, 2007).
• It mainly affects adults and only 5-8% of cases have been in children (Sharma et al, 2015).
• Sometimes there’s a trigger for SS, but in 50% of cases there’s no known trigger.
• Infection (mainly upper respiratory tract and gastrointestinal) and cancer are 2 of the commonest triggers. Paediatric cases less likely to be associated with cancer and are more likely post-infectious (Sharma et al, 2015).
• There are 20 cases of SS associated with vaccination, and 9 of these are associated with SARS-CoV2 vaccine – 3 Pfizer, 2 AstraZeneca, 2 Moderna, 1 Janssen, 1 Sinovac-CoronaVac.
• SS has only been associated with certain vaccinations (see below).

Which vaccinations have been associated with Sweet’s syndrome?

Sweet’s syndrome has been associated with the following vaccinations:

• Bacillus Calmette-Guerin, live attenuated (modified and weakened) vaccine (BCG or tuberculosis) (Carpentier et al, 2002: 82; Cruz-Velasquez et al, 2016). Two cases. One in 1986, occurring 15 days after vaccination, but the authors of the medical article that reported this did not control the tuberculin (Mantoux) test. One reported in 2002, occurring 10 days after vaccination.
• Hepatitis B, inactivated (killed) vaccine (Enokawa et al, 2017). One case in a 69-year-old man with the autoimmune condition, systemic lupus erythematosus. Symptoms of SS started to develop 48 hours after vaccination, but there were no skin lesions at the vaccination site.
• Influenza injection, inactivated (Cruz-Velasquez et al, 2016; Hali et al, 2010, Jovanovic et al, 2005; Tan el al. 2006; Wolf et al. 2009). Four cases. One reported in 2005; in 2006, one case of bullous SS following vaccination in a HIV-infected patient; in 2009, neutrophilic dermatosis of the hands occurring 12 hours after vaccination: in 2010, one case of SS after H1N1 influenza (swine flu) vaccination. Additional note: the nasal spray flu vaccine (FluMist) is live attenuated. There are no reported cases of SS being triggered by it.
• Smallpox, a live vaccine that contains a pox-type virus related to smallpox, but causes a milder disease (Carpentier et al, 2002: 82; Cruz-Velasquez et al, 2016). Two cases reported in 1975, occurring 3 days after vaccination.
• Streptococcus pneumonia, inactivated (Carpentier et al, 2002: 82; Cruz-Velasquez et al, 2016; Pedrosa et al, 2013). Two cases. One reported in 1990, occurring 4 days after vaccination following a splenectomy. One reported in 2013, and the first with the 13-valent conjugate vaccine.
• SARS-CoV2/COVID-19, different types of vaccine (see comments) (Baffa et al, 2021; Darrigade et al, 2021; Hoshina and Orita, 2022; Kinariwalla et al, 2022; Majid and Mearaj, 2021; Pelchat et al, 2022; Salah et al, 2022; Torrealba-Acosta et al, 2021; Zagar et al, 2021). Nine cases – 3 Pfizer, 2 AstraZeneca, 2 Moderna, 1 Janssen, 1 Sinovac-CoronaVac.

Why do vaccinations trigger Sweet’s syndrome?

Possibly hypersensitivity reaction.

What is hypersensitivity reaction?

In SS or those that go on to develop it, the immune system may respond to antigens in a way that it wouldn’t in most people, i.e. is hypersensitive and overreacts or responds in the wrong way to the presence of infectious, inflammatory, drug, or tumour cell antigens (Bhat et al, 2015: 257; Kasirye et al, 2011: 135). Antigens are molecules that stimulate an immune response.

If I have Sweet’s syndrome should I avoid having vaccinations?

No. Most people with SS don’t need to avoid having their vaccinations unless they can’t be vaccinated for other reasons, e.g. they are taking certain types of medication or have other health conditions. If the SS was triggered by a particular vaccination, then it isn’t advisable to have the same kind of vaccination again (doctor may advise otherwise if benefits of vaccine outweigh risks). Ideally, a vaccination shouldn’t be given during a SS flare-up.

How do I know if vaccination has triggered my Sweet’s syndrome?

Symptoms usually develop within hours or days, less commonly, about two weeks after vaccination. Skin lesions may appear at the vaccination site, but this can also happen because of the skin damage caused by having the vaccination (puncture wound from the needle) rather than the vaccine itself. This response is known as pathergy.

References.

Baffa, M., Maglie, R., Giovannozzi, N., Montefusco, F., Senatore, S., Massi, D. and Antiga, E. (2021) Sweet Syndrome Following SARS-CoV2 (COVID-19) Vaccination. Vaccines, Oct 20 (MDPI). Pfizer.

Bhat, Y., Hassan, I., Sajad, P., Akhtar, S. and Sheikh, S. (2015) Sweet’s Syndrome: An Evidence-Based Report. Journal of the College of Physicians and Surgeons – Pakistan, Jul;25(7):525-7 (PubMed).

Carpentier, O., Piette, F. and Delaporte, E. (2002) Sweet’s syndrome after BCG vaccination. Acta Dermato-Venereologica;82(3):221 (PubMed).

Cruz-Velásquez, G., Pac Sha, J., Simal Gil, E. and Gazulla, J. (2016). Aseptic meningitis and anti-β2-glycoprotein 1 antibodies in Sweet syndrome. Neurologia (Barcelona, Spain), Jul 21 (Elsevier). Article in Spanish, use translate.

Darrigade, A., Theophile, H., Sanchez-Pena, P., Milpied, B., Colbert, M., Pedeboscq, S., Pistone, T., Jullie, M. and Seneschal, J. (2021) Sweet syndrome induced by SARS-CoV-2 Pfizer-BioNTech mRNA vaccine. European Journal of Allergy and Clinical Immunology, Jun 18 (Wiley).

Enokawa, M., Giovanella, L., Zardo, B., Cunha, J., Rachid Filho, A., Zeni, L., Bisognin, M., Rosseto, C. and Guimaraes, A. (2017) Sweet’s Syndrome Discharged (Caused) by Hepatitis B Vaccine. Brazilian Journal of Rheumatology, 57(suppl 1):S197 (Science Direct). Article in Portuguese, use translate.

Hali, F., Sbai, M., Benchikhi, H., Ouakadi, A. and Zamiati, S. (2010) [Sweet’s syndrome after H1N1 influenza vaccination]. Annales de Dermatologie et de Venereologie,  Nov;137(11):740-1 (PubMed).

Hoshina, D. and Orita, A. (2022) Sweet syndrome after severe acute respiratory syndrome coronavirus 2 mRNA vaccine: A case report and literature review. Japanese Dermatological Association: The Journal of Dermatology, Jan 17 (Wiley). Pfizer/tozinameran.

Jovanovic, M., Poljacki, M., Vujanovic, L. and Duran, V. (2005) Acute febrile neutrophilic dermatosis (Sweet’s syndrome) after influenza vaccination. Journal of the American Academy of Dermatology, Feb;52(2):367-9 (PubMed).

Kasirye, Y., Danhof, R., Epperla, N. and Garcia-Montilla, R. (2011) Sweet’s Syndrome: One Disease, Multiple Faces. Clinical Medicine & Research, Nov;9(3-4):134-136 (online).

Kinariwalla, N., London, A. O., Soliman, Y. S., Niedt, G. W., Husain, S. and Gallitano, S. M. (2022) A Case of Generalized Sweet’s Syndrome with Vasculitis Triggered by Recent COVID-19 Vaccination. JAAD Case Reports, Jan 2022 (Elsevier). Janssen.

Majid, I. and Mearaj, S. (2021) Sweet Syndrome after Oxford-AstraZeneca COVID-19 vaccine (AZD1222) in an elderly female. Dermatologic Therapy, Sep 29 (Wiley).

Pedrosa, A., Morais, P., Nogueira, A., Pardal, J. and Azevedo, F. (2013) Sweet’s syndrome triggered by pneumococcal vaccination. Cutaneous and Ocular Toxicology, Sep;32(3):260-1 (PubMed).

Pelchat, F., Fournier, C., Perron, E., Gilbert, M. and Delisle, B. (2022) Sweet Syndrome Following Moderna COVID-19 Vaccine: A Case Report. SAGE Open Medical Case Reports: SAGE Journals, Aug 11 (online).

Salah, N.B., Korbi, M., Fadhel, N.B., Safa, I., Chad, F., Njima, M., Belhadjali, H., Amri, M., Aouem, K. and Zili, J. (2022) Sweet Syndrome following SARS-CoV-2 CoronaVac vaccine. Journal of the European Academy of Dermatology and Venerealogy, Jun 20 (Wiley).

Sharma, A., Rattan, R., Shankar, V., Tegta, G. and Verma, G. (2015) Sweet’s syndrome in a 1-year-old child. Indian Journal of  Paediatric Dermatology;16:29-31 (online).

Tan, A., Tan. H., and Lim, P. (2006) Bullous Sweet’s syndrome following influenza vaccination in a HIV-infected patient. International Journal of Dermatology, Oct;45(10):1254-5 (PubMed).

Torrealba-Acosta, G., Martin, J. C., Huttenbach, Y., Garcia, C. R., Sohail, M. R., Agarwal, S. K., Wasko, C., Bershad, E. M. and Hirzallah, M. I. (2021) Acute encephalitis, myoclonus and Sweet syndrome after mRNA-1273 vaccine. British Medical Journal Case Reports, Jul 24 (PMC). Moderna.

Wolf, R., Barzilai, A. and Davidovici, B. (2009) Neutrophilic dermatosis of the hands after influenza vaccination. International Journal of Dermatology, Jan;48(1):66-8 (PubMed).

Zagar, T., Hlaca, N., Brajac, I., Prpic-Massari, L., Peternel, S. and Kastelan, M. (2021) Bullous Sweet syndrome following SARS-CoV-2 Oxford AstraZeneca vaccine. British Journal of Dermatology, Nov 24 (Wiley).

Zamanian, A. and Ameri, A. (2007) Acute febrile neutrophilic dermatosis (Sweet’s syndrome): a study of 15 cases in Iran. International Journal of Dermatology, Jun;46(6):571-4 (PubMed).

2012-present, Sweet’s Syndrome UK