Post COVID - 19 Infection Diffuse Patch Granuloma Annulare in a Female Patient with Rheumatoid Arthritis: A Case Report

Abstract

Introduction: Granuloma Annulare (GA) is a benign, usually self-limited, inflammatory granulomatous skin disorder of unknown etiology and with a diversity of clinical variants. Genetic factors, associations with predisposing diseases along with several triggers such as certain infections and vaccines, have been described, SARS-CoV-2 virus being one of them. Case Presentation: Localized, generalized and subcutaneous forms of GA have been reported following either SARS-CoV-2 infection or vaccination against the virus. Herein we present a case of diffuse patch GA in a middle-aged female patient with medical history of rheumatoid arthritis, one month after catching COVID -19 despite being fully vaccinated against the virus. Discussion: Overall, taking into account the relevant literature, the occurrence of GA after infection with SARS-CoV-2 as well as after vaccination seems to be attributed to the activation of an immunologic reaction rather than to the direct effect of the virus on the skin lesions, with the latest also appearing in the form of diffuse patch rashes. Conclusion: Dermatologists should be aware of such lesions appearing after COVID-19 infection or even vaccination especially in patients with autoimmune diseases.