Bullous Pemphigoid Onset Associated with Influenza Vaccination: A Case Report and Systematic Review of the Literature

Introduction: Bullous skin diseases following influenza vaccination are uncommon, with only a limited number of cases reported to date. A notable proportion of these cases involved bullous pemphigoid. Objective: We describe a case of bullous pemphigoid in an 88-year-old man occurring after influenza vaccination. This paper also provides a systematic literature review on cases of bullous eruptions following influenza vaccination. Methodology: We performed a systematic literature review to identify studies documenting cases of de novo bullous eruptions occuring after influenza vaccination, as well as cases where pre-existing bullous eruptions were exacerbated following influenza vaccination. Descriptive statistics were employed to present the data. Results: Our patient presented with tense bullae and erosions symmetrically distributed on extensor surfaces of the upper arms, forehead, anterior neck, and intergluteal fold approximately two days after an influenza vaccination. Diagnostic tests confirmed the diagnosis of bullous pemphigoid of moderate severity. Treatment with oral and topical glucocorticoids led to a satisfactory response, with no relapses noted during the ten-month follow-up. BP was the most frequently reported bullous skin disease following influenza vaccination. Other common diseases included bullous leukocytoclastic vasculitis, generalized bullous fixed drug eruption and pemphigus vulgaris. Most patients were elderly, with a male predominance and a latency period ranging from hours up to five weeks. Most patients responded well to treatment, while there were no reported cases of mortality. Conclusion: Bullous skin diseases occurring after influenza vaccination typically exhibit a favorable response to treatment. Pharmacovigilance and reporting of suspected adverse drug reactions are essential to good clinical practice and drug safety.