A Case of Pityriasis Rosea Following Monkeypox Vaccination

Main Article Content

Kaylin Beiter
Anna Swigert
Boni Elewski

Keywords

Pityriasis Rosea, Monkeypox, Vaccine

Abstract

Introduction: Pityriasis rosea (PR) is a well-known but uncommon, benign papulosquamous skin condition that often occurs after viral infections or vaccinations. The most commonly implicated vaccine is smallpox. Monkeypox (MPX), a related virus to smallpox within the orthopox family, has recently grown in public health concern. We present here a case of PR following MPX vaccination in an African-American man.


Case Report: A 32-year old African-American man presented for evaluation of a one-month history of rash that first appeared as an isolated itching spot on his right mid-back, followed by papular eruptions on his trunk with extremity sparing. He denied recent illnesses, medication use including NSAIDs, or history of similar rash. He did report receiving his first MPX dose about one week prior to rash onset. Pityriasis rosea was diagnosed based on clinical presentation and suspected secondary to the patient’s MPX vaccine course.


Conclusion: There are currently two available vaccines for MPX protection in the United States, both of which are vaccinia-based and developmentally related to the smallpox vaccine. Given the known association of smallpox and PR, PR reactions following MPX vaccination may occur.

References

1. Witherspoon FG, Thibodaux DJ. Pityriasis-Rosea-like Eruption Following Smallpox Vaccination. JAMA Dermatology. 1957;76(1):109-110. doi:10.1001/archderm.1957.01550190113025

2. Leung AKC, Lam JM, Leong KF, Hon KL. Pityriasis Rosea: An Updated Review. Curr Pediatr Rev. 2021;17(3):201-211. doi:10.2174/1573396316666200923161330

3. Simpson K, Heymann D, Brown CS, et al. Human monkeypox - After 40 years, an unintended consequence of smallpox eradication. Vaccine. 2020;38(33):5077-5081. doi:10.1016/j.vaccine.2020.04.062

4. Bunge EM, Hoet B, Chen L, et al. The changing epidemiology of human monkeypox-A potential threat? A systematic review. PLoS Negl Trop Dis. 2022;16(2):e0010141. doi:10.1371/journal.pntd.0010141

5. Drago F, Ciccarese G, Javor S, Parodi A. Vaccine-induced pityriasis rosea and pityriasis rosea-like eruptions: a review of the literature. J Eur Acad Dermatology Venereol. 2016;30(3):544-545. doi:10.1111/jdv.12942

6. Rao AK, Petersen BW, Whitehill F, et al. Use of JYNNEOS (Smallpox and Monkeypox Vaccine, Live, Nonreplicating) for Preexposure Vaccination of Persons at Risk for Occupational Exposure to Orthopoxviruses: Recommendations of the Advisory Committee on Immunization Practices — United States, 2022. Morb Mortal Wkly Rep. 2022;71(22):734–742. doi:10.15585/mmwr.mm7122e1

7. Volz A, Sutter G. Modified Vaccinia Virus Ankara. Adv Virus Res. 2017;97:187–243. doi:10.1016/bs.aivir.2016.07.001

8. Islam R, Hossain J, Roy A, et al. Repositioning potentials of smallpox vaccines and antiviral agents in monkeypox outbreak: A rapid review on comparative benefits and risks. Heal Sci Reports. 2022;5(5):e798. doi:10.1002/hsr2.798

Most read articles by the same author(s)