Month: August 2022
Trudeau’s deputy prime minister tried to hide Nazi family history and mother’s ties to George Soros
(LifeSiteNews) – Canadian Deputy Prime Minister Chrystia Freeland hails from a family with professional ties to Adolf Hitler’s Nazi Party as well as infamous globalist oligarch George Soros.
In January, just as the Freedom Convoy was arriving in Ottawa, and as tensions between Russia and Ukraine were heating up, Freeland tweeted a letter of support for Ukraine.
In the letter, she stated, “Canadians — our own parents and grandparents — fought and died to establish a rules-based international order during and after the Second World War.”
While it is true that many Canadians come from ancestry where this would be the case, Freeland’s Ukrainian maternal grandfather, Michael Chomiak, was working to help the Nazis overthrow Europe.
This is not to say that Freeland is a Nazi or Nazi collaborator due to family lineage, but it is the case that she has obscured her family history on multiple occasions, and has portrayed her grandfather as some sort of liberal or democratic actor.
Jewish internet publication the Tablet catalogued the numerous times that Freeland spoke of her Ukrainian heritage while painting a picture of her grandfather as a political exile rather than a Nazi-aligned anti-semite.
Nazi political hero
In 2015, Freeland published a series of reflections about her Ukrainian heritage entitled My Ukraine for The Brookings Essay, where she stated the following: “My maternal grandparents fled western Ukraine after Hitler and Stalin signed their non-aggression pact in 1939. They never dared to go back, but they stayed in close touch with their brothers and sisters and their families, who remained behind.”
She continued, “For the rest of my grandparents’ lives, they saw themselves as political exiles with a responsibility to keep alive the idea of an independent Ukraine, which had last existed, briefly, during and after the chaos of the 1917 Russian Revolution. That dream persisted into the next generation, and in some cases the generation after that.”
In her portrayal of her grandfather she failed to admit or mention that he was editor of Krakivski Visti, a Nazi propaganda paper that operated out of Poland during the time of Nazi occupation.
She did, however, mention neo-nazis, but in the section of her lengthy series of essays entitled Putin’s Big Lie, where she opined, “Putin has depicted Ukrainians who cherish their independence and want to join Europe and embrace the Western democratic values it represents as, at best, pawns and dupes of NATO — or, at worst, neo-Nazis.”
In a 2015 piece from the Toronto Star that promoted Freeland as “Trudeau’s first star,” again Freeland mentioned her grandfather multiple times, but never stated he was a Nazi.
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She is quoted as saying, “All my grandparents loved Canada, but my Ukrainian grandfather was the most passionate.”
The same article did mention the Nazis, but only in reference to the historical presence of where her family came from.
In 2016, she tweeted in a post that has since been deleted, “Thinking of my grandparents Mykhailo and Aleksandra Chomiak … They were forever grateful to Canada for giving them refuge and they worked hard to bring freedom and democracy to Ukraine.”
Russian disinformation
Eventually, in 2017, reports of Freeland’s Nazi family history began to surface in Russian and Polish media outlets, but Freeland claimed that it was nothing more than Russian disinformation.
Freeland told reporters, “American officials have publicly said, and even Angela Merkel has publicly said, that there were efforts on the Russian side to destabilize Western democracies, and I think it shouldn’t come as a surprise if these same efforts were used against Canada.”
However, the Canadian press finally caught on, and it was revealed in March 2017 that Freeland’s grandfather was working with the Nazis.
There is evidence, however, that Freeland was well aware of her grandfather’s Nazi collaboration.
In 1996, Freeland’s uncle wrote a paper outlining his father-in-law’s involvement with the Nazis, and in the first footnote he thanked his niece, Chrystia Freeland – who was at the time a journalist – for her editorial assistance.
Mom worked with Soros
Chrystia Freeland’s mother was a lawyer in Canada for many years, and eventually took on a role of working in Ukraine after the Soviet Union had fallen. She started a foundation called the Ukrainian Legal Foundation, which had the ostensible goal “to work for the establishment of the rule of law in Ukraine.”
The foundation established much of the legal framework in present-day Ukraine, including the first legal library and a law school.
The foundation was funded by billionaire and globalist George Soros, who admitted in the 1990s to having collaborated with the Nazis to outs Jews from their homes in Ukraine as a young man, and showed no visible remorse during an episode of 60 Minutes that has become famous.
There is no evidence that Chrystia Freeland herself is a Nazi or Nazi sympathizer, but Canadians have a right to know that the minister who co-opted the power of the banking system to punish Freedom Convoy participants earlier this year, comes from a family that has been politically active with some of the worst people on earth for decades.
‘Absolutely devastating’: Ex-transgender woman sues doctor after having womb, breasts removed
(LifeSiteNews) – Earlier this month, the news broke that up to 1,000 families were likely to sue the soon-to-be-shut down Tavistock gender clinic over allegations that the “affirmative” model resulted in thousands of children being put on hormones and puberty blockers and given surgeries without fully understanding what they were consenting to or being aware of the irreversible damage they were incurring. Legal experts and commentators have been predicting a wave of medical malpractice lawsuits for years; many wondered if the Tavistock class-action is a harbinger of things to come.
A story in the Sydney Morning Herald by Julie Szego indicates that Australia’s gender ideologues may also be facing a judicial reckoning. Jay Langadinos is suing psychiatrist Dr. Patrick Toohey for professional negligence for prescribing her masculinizing hormones without doing the necessary psychiatric evaluations in May of 2010, when she was struggling with gender dysphoria and erroneously identifying as male. She was referred to Toohey by her endocrinologist. On her first visit, Toohey diagnosed her with gender dysphoria and “found she was suitable for hormone therapy, in this case testosterone, which encourages the development of male secondary sexual characteristics.”
At their second appointment in February 2012, Toohey approved Langadinos for a double mastectomy—the removal of her healthy breasts—which she underwent in April. In May at their third appointment, Toohey approved a hysterectomy, stating that he could not discern “any psychiatric contraindication to proceeding with hysterectomy as part of gender transition.” In November of that year, at the age of 22, Langadinos had her womb surgically removed. But with each surgery, Langadinos found herself feeling more deeply depressed despite her belief that hormones and surgeries would bring her happiness.
When Langadinos realized that gender transition was only making her mental health worse, she sought other psychiatric help. In November of 2016, while under the care of Dr. Robert D’Angelo, she realized that the hormones and the surgeries had been a mistake. In 2020, she stopped taking hormones completely. She stopped identifying as a man, and began to realize the extent of the damage that had been done by “transition.” Toohey, she says, “failed to take the precautions” to ensure that the “loss of her breasts, uterus, fallopian tubes, and ovaries” would not irreparably harm her, as she now believes. She also states that Toohey should have told her to get a second psychiatric opinion before such a drastic step.
Langadinos’ lawsuit pours fuel on the fiery debate surrounding the “gender affirming” model in Australia. Her story is also the latest high-profile case of a de-transitioner forcing their story into the mainstream and shedding light on the dangers of transition. “Knowing I can’t have children is absolutely devastating,” she told the Herald. In addition to that, she also “has suffered and continues to suffer from injuries and disabilities” due to her hormone therapy, including “complications from early menopause,” “impaired psychological functioning, an ongoing need for medical treatment and diminished capacity for employment.” She had believed as a teenager that she was transgender because of her complicated home life—a psychiatrist fulfilling his duty, she believes, would have interrogated her past before putting her on the path to transition.
READ: Notorious UK trans surgery clinic closes up shop, but it’s not all good news
Anna Kerr, the lawyer with the Feminist Legal Clinic of New South Wales who sent Langadinos’ case to the legal firm Slater and Gordon, told the Herald that her lawsuit is “likely to be the tip of the iceberg. We can expect to see extensive litigation in future years related to gender-affirming cross-sex hormones and surgeries.” If that happens, the medical cottage industry that has sprung up to meet the exploding demand for “sex changes” in young people may find themselves under siege—and each time one of these cases makes the news, the chilling effect on those seeking transition and those willing to facilitate transition is likely to grow.
Another One: Poultry Processing Plant Catches Fire in Montebello, California (VIDEO)
A poultry processing plant in Montebello, California was caught on fire on Sunday.
A representative for the city of Montebello said that QC Poultry, located at 1111 W. Olympic Blvd., had building damaged and that numerous commercial cars may have been destroyed by fire, according to KTLA.
The fire was contained with the help of Montebello Fire and other mutual aid fire departments.
“Shortly after 4:00 p.m. on Sunday, August 28, your [Montebello Fire Department] responded to a reported structure fire in the 1000 block of Olympic Blvd,” Montebello FD wrote on Instagram.
“First arriving units on scene found a large industrial building with heavy smoke showing. As members began to deploy, the fire was upgraded to a third alarm commercial fire.”
The cause of the fire is unknown.
Ralph Baric’s Bio Terrorist lab spent a considerable amount of time and money in the 80s/90s researching how to induce heart disease with coronaviruses.
- National American Heart Association Grant in Aid. Coronavirus-induced myocarditis in
rabbits. July 1987-June 1990. $29,609 first year; total for three years: $94,227 (direct
costs), PI: RS Baric 10% effort. - Career Development Award from the National American Heart Association,
Established Investigator Award “Coronavirus-Induced Rabbit Cardiomyopathy”.
Established Investigator-American Heart Association. Direct costs: $175,000. 7/1/89 –
6/30/94. PI: RS Baric - School of Public Health, BRSG. Coronavirus-induced myocarditis in rabbits. 1986-1987.
$7,150 Direct costs. PI: RS Baric - School of Public Health, BRSG. Incidence of the enteric rotaviruses, adenoviruses, and
coronaviruses among migrant farm workers. 1987-88. Direct costs $7,150. PI: RS Baric - School of Public Health, BRSG Small Instrument Program. Direct costs $7,477.80. PI:
RS Baric. 1989
Curriculum Vitae-Baric, Ralph S.
- 6 –
- National American Heart Association Grant in Aid. “Coronavirus-induced myocarditis
and dilated cardiomyopathy. 7/1/90 – 6/30/93. Direct costs $108,000. PI: RS Baric, 10%
effort
- Alexander, L.K., Small, J.D., Edwards, S.W. and R. S. Baric. 1992. An experimental model
for dilated cardiomyopathy following rabbit coronavirus infection. Journal Infectious
Diseases 166(5):978-85. PMID:1328411 - De Leon, R., Sobsey, M.D., Matsui, S.M., Baric, R.S., Herrmann, J.E., Blacklow, N.R., and
Greenberg, H.B., 1992. Detection of Norwalk virus in stool specimens by reverse
transcriptase-polymerase chain reaction and non-radioactive oligo probes (RT-PCR-OP).
J. Clin. Microbiol. 30(12):3151-3157. PMCID: PMC270605 - Edwards, W., Small, J.D., Geratz, D., Alexander, L.K. and Baric, R.S., 1992. A model for
Virus-induced myocarditis and congestive heart failure in Rabbits. J. Infectious Diseases
165(1):134-140. PMID:1309370 - Fu, K. and Baric, R.S. 1992. Evidence for variable rates of recombination in the MHV
genome. Virology 189(1):88-102. PMID:1318616 - Baker, S.C, Gao-HQ and Baric, R.S. 1993. Altered proteolytic processing of the
polymerase polyprotein in RNA(-) TS mutants of mouse hepatitis virus. Adv. Exp. Med.
Biol. 342:215-9. PMID:8209733
Curriculum Vitae-Baric, Ralph S.
- 13 –
- Alexander, L.K., Keene, B., Small, J.D. and Yount, B Jr, Baric, R.S. 1993.
Electrocardiographic changes associated with rabbit coronavirus induced myocarditis and
dilated cardiomyopathy. Adv. Exp. Med. Biol. 342:365-370. PMID: 8209755
Environment Canada confirms The Counter Signal documents are ‘authentic’
Environment and Climate Change Canada has confirmed documents published by The Counter Signal revealing a new Winnipeg facility hosting a firearms armoury are “authentic.”
Last week, The Counter Signal reported that the Ministry of Environment & Climate Change Canada (ECCC) is building a new facility, which includes biological labs, media relations offices, intelligence facilities and “controlled quiet rooms.”
In an emailed statement, Environment Canada confirmed documents first published by The Counter Signal are “authentic” — and that some enforcement officers are entitled to weapons to carry out their duties.
“The floor plans in the Counter Signal article are authentic,” confirmed spokesperson Amelie Desmarais. “They were shared publicly in July 2021 as part of a contracting process to secure services to renovate the floors occupied by ECCC, mainly to align with Government of Canada GCWorkplace standards.”
As previously reported by The Counter Signal, the facility will be over 50,000 square feet and house hundreds of Environment Canada and weather forecasting staff.
Environment Canada said its enforcement branch is mandated to enforce federal environmental legislation aimed at pollution prevention and protecting Canada’s wildlife and biodiversity. Enforcement responsibilities cover more than 60 regulations.
The department said the agency has officers across Canada under Environment Canada legislation and the Criminal Code. These officers have powers and protections of Peace Officers, the agency said.
“They have the authority to issue enforcement actions,” Desmarais explained.
“A limited number of ECCC employees are authorized and trained to carry firearms in the context of their duties.”
Enforcement officers require “specialized tools” to perform their duties and “keep them safe,” Desmarais said. They also require facilities to house and secure the tools, the department said.
Desmarais said officers routinely take witness statements when working on files and “so we have specially designed interview rooms for this purpose.”
Speaking about the facility’s “controlled quiet rooms,” the department said some offices include closed “quiet rooms” for work requiring a high degree of concentration. “Control” indicates that only employees with access can enter this secure area.
“Those specific areas are essential to the Enforcement’s integrity, security and operational efficiency for both investigative and inspection processes,” Desmarais said.
According to an Indeed job listing, the Ministry is searching to recruit Climate “Pollution” Officers under its “Environmental Enforcement Directorate.”
The department added that it’s currently hiring new officers to maintain its existing workforce.
The leak comes days after Environment Canada agents allegedly trespassed on Saskatchewan farmland.
Landowners who confronted the federal agents were told agents were testing water in farmers’ dugouts to measure nitrate levels. ECCC said it was collecting samples in water bodies, but “no nitrates or other nutrients.”
Nitrogen levels in fertilizer are the newest target of Trudeau’s climate agenda. The Trudeau government recently announced a “voluntary” initiative to reduce fertilizer use on Canadian farms by 30%.
Canadian Government Is Hiring Guard Services for “Safe, Voluntary” COVID Internment Camps
https://buyandsell.gc.ca/procurement-data/tender-notice/PW-ZL-100-41082
mportant update: In order to make residents of “safe, voluntary” COVID Internment camps feel even safer, the Canadian government is hiring guard services:
Ontario’s COVID advisory group set to be dissolved in September
TORONTO (LifeSiteNews) – The Ontario Science Table, an independent group of public health advisers to the Ontario government, announced it will fold in September, more than two years after it was created.
The table had a modeling group that was responsible for frequent COVID-19 projections that were frequently incorrect, grossly overestimating the effect of COVID in Ontario on multiple occasions.
In April, Dr. Peter Juni, the head of the group of scientists, told reporters that Ontario was in the midst of a COVID spike as large or larger than anything the province had seen, even as hospitalizations were at all-time lows and the province was beginning to open up fully.
He told the CBC that he estimated 100,000 to 120,000 new cases of COVID daily were going unreported, which was exponentially higher than the numbers reported and which would have lowered the risk of COVID, as deaths did not rise with the supposed rise in cases.
Juni estimated at the time that almost five million Ontarians had been infected with COVID between December 2021 and April 2022.
Another member of the group — David Fisman, an epidemiologist and professor at University of Toronto – was accused by the Toronto Sun of operating under a conflict of interest in his capacity as an adviser to both the government and a major teacher association.
Fisman was retained by the Elementary Teachers’ Federation of Ontario to argue against opening schools. This work was taken on at the same time Fisman was serving on the science table, which advised the government on matters including school reopenings.
Fisman did end up updating is declaration of interests, but only after the Sun had exposed the potential conflict.
As Canada remains one of the last jurisdictions in the developed world with strict COVID measures – such as the highly controversial entrance restrictions for Canadian citizens – a spokesman for the table said that the “pandemic” remains a “daunting challenge.”
This comment comes as a public health adviser, speaking for the government of the province of Quebec, said that for some age groups COVID has proved to be less dangerous than the flu.
Toxic epidermal necrolysis after first dose of Pfizer-BioNTech (BNT162b2) vaccination with pharmacogenomic testing
Abstract
Toxic epidermal necrolysis (TEN) is a rare and acute life-threatening condition and one of the severe cutaneous adverse drug reactions. There are limited data on TEN from the COVID-19 vaccine regarding its pathogenesis, treatment, and prognosis, particularly in children. We report a case of COVID-19 vaccine-induced TEN and the patient’s human leukocyte antigen pharmacogenomic profile.
1 INTRODUCTION
Toxic epidermal necrolysis (TEN) is a rare, acute, life-threatening, drug-related disease, which has an estimated mortality rate of 14.8%–48%1, 2 and an annual incidence of 0.4–1.2 cases per million from various culprit drugs.3
There have been a small number of case reports of patients who have developed Stevens-Johnson syndrome (SJS)/TEN following COVID-19 vaccine. Here we present the case of a 12-year-old girl with TEN after her first dose of Pfizer-BioNTech (BNT162b2) vaccine.
1.1 Case presentation
A healthy 12-year-old girl with no previous medical history presented 6 days after her first dose of Pfizer-BioNTech (BNT162b2) vaccine. Two days after vaccination, she developed a low-grade fever with a mild sore throat. The patient did not take any oral prescribed or over-the-counter medications or herbal remedies during the past 8 weeks. On the 6th day after the vaccine, there were erythematous, painful patches and plaques on the chest wall and trunk, which subsequently spread to the face, palms, and soles. Mucocutaneous erosions were observed in the ocular, oral, and genital regions. She was diagnosed with TEN and immediately admitted to the pediatric intensive care unit.
During the first day of admission, the rash rapidly coalesced and she developed tense bullae, prominently seen on both cheeks and left arm. (Figure 1) Multiple, tiny bullae, dusky patches, and macules were observed. Her lips and oral mucosa were covered with painful hemorrhagic crusts and genital mucosal lesions appeared. She had conjunctival and mucopurulent discharge from both eyes. Asboe-Hansen sign was noted all over the body. She was estimated to have epidermal detachment over 40% of the body surface area. (Figure 2).
Complete blood count, standard chemistry panels, transaminases, and urine analysis were all within normal limits. Chest radiography was normal with negative serology for Mycoplasma pneumoniae, Epstein–Barr virus, and human immunodeficiency virus (HIV). Pediatric SCORTEN was 2 on the first day of admission, reflecting a heart rate over 120 beats per minute and epidermal detachment area involving BSA >30%. Histopathology showed subepidermal bullae, full thickness epidermal necrosis, patchy areas of basal cell degeneration and necrotic keratinocytes and interface dermatitis with perivascular inflammatory cell infiltration (Figure 3). Human leukocyte antigen (HLA) class I and II alleles were determined using PCR sequence-specific oligonucleotide probes. The HLA genotyping in the patient showed HLA-A*02:03/31:01, HLA-B*13:01/15:27, HLA-C*04:01/04:06, HLA-DRB1*04:06/15:02, HLA-DQB1* 03:02/05:01, HLA-DQA1* 01:01/03:01.
Intravenous immunoglobulin (IVIG) (2 g/kg) was given within 24 h after diagnosis, in conjunction with nonpharmacologic treatments, such as fluid, electrolyte and nutritional support, and wound management. No prophylactic antibiotics were prescribed.
Clinical improvement occurred on the second day after IVIG administration, with defervescence of fever and no new skin lesions. Reepithelialization of the skin was noticed on the 7 day after admission. The patient had complete skin reepithelialization on the 12 day after admission, with a total hospitalization of 18 days. She had a full recovery without sequelae.
2 DISCUSSION
SJS/TEN is an extremely rare adverse event from basic vaccination. In addition, cases of SJS/TEN associated with the COVID-19 vaccine have been rarely reported and are summarized in Table 1.4–12TABLE 1. Reported cases of COVID-19 vaccine induced SJS/TEN
| Author’s name, Reference | Age (years) | Gender | Underlying diseases, drug | Vaccine | Dose | Onset duration after vaccination (days) | Diagnosis | Skin biopsy | SCORTEN | Laboratory | Treatment | Recovery time (days) | Prognosis |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Bakir M, et al.4 | 49 | F | No | Pfizer-BioNTech(BNT 162b1) | First dose | 7 days | TEN | Confirmed | 2 (1 day) | AST 178 U/LALT 90 U/LCXR-normal | Etanercept × 2 doses | 22 days | Good |
| Elboraey MO, et al.5 | “Middle-age” | F | N/R | Pfizer-BioNTech(BNT 162b1) | Second dose | 5 days | SJS | Not done | N/R | N/R | Oral prednisolone(30 mg/day) | N/R | Good |
| Dash S, et al.6 | 60 | M | DM-metformin, teneligliptinHT- amlodipine | Astra Zeneca(ChAdOx1 nCoV-19) | First dose | 3 days | SJS | Confirmed | 1 (1 day) | N/R | Cyclosporine 300 mg | 7 days | Good |
| Mansouri P, et al.7 | 49 | F | Breast cancer(tamoxifen, sodium valproate, alprazolam) | Sinopharm, (China National Biotec Group) | Second dose | 3 days | SJS(mild symptoms) | Confirmed | N/R | N/R | Oral prednisolone(30 mg/day) | 14 days | Good |
| Mardani M, et al.8 | 76 | M | Hyperlipidemia (atrovastatin) | China National Biotec Group) | First dose | 1 day | TEN | Confirmed | N/R | AST 90 U/LALT 82 U/LCXR-normal | Oral prednisolone | 14 days | Good |
| Aimo C, et al.9 | 65 | M | No | Vaxvetria (AZD1222) | Second dose | 10 days | SJS | Confirmed | N/R | -Thrombocytopenia-Elevated CRP, LDH, fibrinogen, D-dimer-Sagittal sinus thrombosis | Oral prednisolone(1 mg/kg/day) | Within 8 weeks | Good |
| Kherlopian A, et al.10 | 48 | F | N/R | Astra Zeneca(ChAdOx1 nCoV-19) | First dose | 14 days | TEN | Confirmed | 2 (day-not reported) | -Serology: M. pneunoniae, herpes simplex virus, adenovirus, HIV, hepatitis B, C- negative | Etanercept × 3 doses | 35 days | Good |
| Mansouri P, et al.11 | 63 | F | Psoriasis,DM- Sitagliptin, metformin | Sinopharm, (China National Biotec Group) | First dose | 1 day | SJS | Confirmed | N/R | -CBC, BUN, Cr- normal-HbA1C 6.4% (normal 4%–5.6%) | Oral prednisolone(40 mg/day) | 3 weeks | Good |
| Padniewski JJ, et al.12 | 46 | F | Hyperlipidemia- atorvastatinObesityDM- metformin | Moderna(Moderna Inc., MRNA 1273) | First dose | 3 days | SJS | Confirmed | N/R | -Serology: M. pneunoniae, herpes simplex virus, varicella, tuberculosis, hepatitis B, C- negative-CXR-normal | Oral prednisolone(80 mg/day) | 6 days | Good |
| Our case | 12 | F | No | Pfizer-BioNTech(BNT 162b2) | First dose | 6 days | TEN | Confirmed | 2 (1 day):Pediatric SCORTEN | Normal | IVIG 2 g/kg/day | 12 days | Good |
- Abbreviations: F, female; M, Male; N/R, not reported.
There have been only nine reported cases of SJS/TEN after COVID-19 vaccine. Five of these patients had underlying diseases, such as hyperlipidemia, diabetes mellitus and breast cancer with a history of medication use.6–8, 11, 12 Most cases of SJS/TEN occurred following the first dose of COVID-19 vaccine. The onset of SJS/TEN after vaccination was about 1–2 weeks (1–14 days). However, underlying diseases, vaccine type, concomitant factors (medication type and duration of treatment, and probably infection) could be additional predisposing factors for SJS/TEN. From the literature review, treatments included anti-tumor necrosis factor-alpha (anti TNF-α), prednisolone, cyclosporine, and IVIG. All patients had a good prognosis, with a complete time of resolution ranging from 7 days to 35 days. The hospitalization time of drug-induced SJS/TEN in a previous study was 11.8 ± 10.6 days.13 However, long-term sequelae should be monitored.
Our case was treated with IVIG due to concern regarding the side-effects of other treatments, including systemic corticosteroids and cyclosporine. Being in a resource-limited setting, we were unable to use anti-TNF-alpha agents in Thailand. Despite clinical data from a systematic review and meta-analysis in 201714 regarding the nonusefulness of IVIG, other systematic reviews and meta-analyses in 2012 and 2015 suggested that IVIG was beneficial in reducing mortality in children when compared to studies in adults.15 Dosages of ≥2 g/kg appeared to significantly decrease mortality in patients with SJS or TEN.16 Thus, IVIG use in pediatric patients is another option in a country with limited resources.
The COVID-19 vaccine is comprised of virotopes and excipients (L-histidine, L-histidine hydrochloride, sucrose, sodium chloride, polysorbate 80, ethanol, water, polyethylene glycol [PEG-2000] and others). The most likely causative vaccine component in one case report was thought to be the virotopes.6 The presumptive hypothesis of SJS/TEN from routine vaccination was proposed by Chahal et al.17The expression of virotopes on the surface of keratinocytes is similar to drug antigens on keratinocytes that can potentially activate a CD8+ T-cell lymphocyte response. This activation induces the release of chemokines, cytolytic molecules, cytotoxic agents, and enzymes, such as granulysin, granzyme B, and perforin, leading to keratinocyte apoptosis and detachment of epidermis.17,18
mRNA vaccines initially activate toll-like receptor-7/8 (TLR7/8) and retinoic acid-inducible gene-1-like (RIG-I-like) receptors (RLRs), inducing a cellular immune response embraced by CD8+ T cells and macrophages with a T-helper 1 cell profile (Th1). Key cytokines include interferon-γ (IFN-γ), tumor necrosis factor-α (TNF-α), and interleukin(IL)-2 and IL-6.19
The implementation of pharmacogenomics in clinical practice represents a feasible and likely useful enhancement to the therapeutic management of medication-induced adverse events. Pharmacogenomics may have a role in personalized vaccination plans and potentially could reduce adverse events. HLA encoded by the HLA gene are an important modulator of the immune response and drug hypersensitivity reactions. HLA variants can be a risk factor for developing potentially fatal drug and vaccine-induced hypersensitivity reactions. Interestingly, specific HLA genotypes that confer genetic susceptibility to SCARs have been found in this patient (HLA-A* 31:01-carbamazepine, HLA-B*13:01-cotrimoxazole and dapsone, HLA-DRB1*15:02-allopurinol).20 We hope that the HLA-pattern of this patient might be beneficial for future research on drug susceptibility, particularly of vaccines.
3 CONCLUSION
The impact of COVID-19 infection is well-recognized all over the world. To date, 3.15 billion doses of vaccines have been provided with only 10 cases (including our reported case) of SJS/TEN. The occurrence of SJS/TEN is extremely rare and the benefits of vaccination clearly outweigh the risks.
In our case, we describe how early IVIG administration was as an effective and safe treatment for TEN induced Pfizer (BNT162b2) vaccination. We also report the HLA pharmacogenetic biomarkers of this patient: HLA-A* 02:03/31:01, HLA-B* 13:01/15:27, HLA-C* 04:01/04:06, HLA-DRB1* 04:06/15:02, HLA-DQB1* 03:02/05:01, HLA-DQA1* 01:01/03:01.
FUNDING STATEMENT
None declared.
CONFLICT OF INTEREST
None declared.
Bullous pemphigoid after SARS-CoV-2 vaccination: spike-protein-directed immunofluorescence confocal microscopy and T-cell-receptor studies
Dear Editor, Growing evidence suggests that SARS-CoV-2 vaccination is associated with a variety of cutaneous reactions. These include autoimmune-mediated conditions such as autoimmune blistering diseases (AIBDs), one of which is bullous pemphigoid (BP).1, 2 We report new-onset BP in two patients following their first SARS-CoV-2 vaccination.
The first patient was an 80-year-old man who noticed reddish itchy macules with small blisters on his lower legs 1 week after vaccination with BTN162b2.2 Two weeks later, after he had received his second shot, these erythematous/bullous lesions spread over his trunk (Figure 1a). The second patient was an 89-year-old man who noticed 2 days after the first BTN162b2 vaccination itchy erythematous/bullous lesions on his entire integument. Neither of the patients reported intake of any new medications or other newly diagnosed conditions prior to the AIBDs.
In both cases, subepidermal clefts were demonstrated on routine histology (Figure 1b). In both patients, direct immunofluorescence on frozen sections revealed linear deposits of IgG and C3 at the basement membrane zone. Indirect immunofluorescence showed bandlike IgG deposits on the epidermal side in both patients. In both cases, enzyme-linked immunosorbent assay revealed highly elevated autoantibody levels against BP-180 (365 U mL−1 and 115 U mL−1, normal range < 20) and BP-230 (223 U mL−1 and 41 U mL−1, normal range < 20). Hence, both patients were diagnosed with BP. Both were successfully treated with a tapered systemic prednisolone regimen.
For immunofluorescence confocal laser scanning microscopy imaging, we used the antibody SARS-CoV/SARS-CoV-2 Spike Protein S2 [mouse/IgG1, monoclonal antibody (clone 1A9), catalogue no. MA5-35946 (Thermo Fisher Scientific, Waltham, MA, USA)]. We did not observe immunoreactivity for SARS-CoV-2 spike protein in the subepidermal compartment. There was only a very likely unspecific immunoreactivity in the horny layer of the patient and control skin specimens (Figure 1c, d). High-throughput sequencing of the T-cell receptor (TCR)Vβ CDR3 and TCR repertoire was investigated in lesional skin tissue and isolated peripheral blood mononuclear cells. Within the lesions of both patients, we observed a high clonality of T cells, with the top expanded T-cell clone contributing almost 20% of all TCR transcripts (Figure 1e).
Using TCRMatch3 to estimate the antigen specificity of the expanded T-cell clonotype we found that several of the expanded T-cell clones were indeed reactive to SARS-CoV-2 (Figure 1f). Using the GLIPH algorithm,4 we identified several TCR clusters derived from T cells in both lesional tissue and peripheral blood that co-clustered with the added spike-protein-reactive TCRs (Figure 1g). Importantly, by contrast, in control tissues obtained prior to the COVID-19 pandemic or SARS-CoV-2 vaccinations, SARS-CoV-2 spike-protein-reactive T cells were not observed (data not shown).
The similarities with respect to both timing and the clinical and molecular features in the cases presented here point to a causal relationship between the vaccination and BP. There are several published cases of vaccine-induced BP, the majority involving influenza but more recently also COVID-19.1, 5, 6 For SARS-CoV-2 vaccines, the target antigen is the surface spike protein, which is used by the virus to bind and fuse with host cells. When speculating on autoimmune mechanisms following SARS-CoV-2 infection one may particularly consider molecular mimicry.7, 8 We hypothesized that molecular mimicry may exist between basement-membrane-specific proteins (e.g. BP-180, BP-230) and the SARS-CoV-2 spike protein. However, using an antibody against the spike protein we could not confirm this hypothesis.
With respect to the TCR repertoire in lesional skin, we observed a marked clonal expansion of T cells in both patients with BP, indicating an ongoing adaptive immune response. However, we cannot exclude that this T-cell expansion was an epiphenomenon due to the vaccination per se. The two bioinformatic approaches further suggested that these T-cell responses were reactive to SARS-CoV-2-derived epitopes.3, 4 Our TCRMatch results suggested that some of the expanded T-cell clones detected in the patients might be reactive to other SARS-CoV-2-derived epitopes including nucleocapsid proteins. However, whether these T-cell clones might hint at an undocumented previous infection with SARS-CoV2 or some other mechanism, whereby a spike protein vaccine may induce such T cells, remains unclear at this point.
Author Contribution
Thilo Gambichler: Investigation (equal); Visualization (equal); Writing-review & editing (equal). Nazha Hamdani: Formal analysis (equal); Investigation (equal); Methodology (equal); Supervision (equal); Writing-review & editing (equal). Heidi Budde: Investigation (equal); Methodology (equal); Writing-review & editing (equal). Marcel Sieme: Investigation (equal); Methodology (equal); Visualization (equal); Writing-review & editing (equal). Marina Skrygan: Investigation (equal); Methodology (equal); Supervision (equal); Writing-review & editing (equal). Lisa Scholl: Investigation (equal); Visualization (equal); Writing-review & editing (equal). Heinrich Dickel: Data curation (equal); Supervision (equal); Writing-review & editing (equal). Bertold Behle: Data curation (equal); Investigation (equal); Writing-review & editing (equal). Nomun Ganjuur: Data curation (equal); Investigation (equal); Writing-review & editing (equal). Christina Scheel: Validation (equal); Writing-review & editing (equal). Nessr Abu Rached: Data curation (equal); Investigation (equal); Writing-review & editing (equal). Lennart Ocker: Formal analysis (equal); Investigation (equal); Writing-review & editing (equal). Rene Stranzenbach: Investigation (equal); Supervision (equal); Writing-review & editing (equal). Martin Doerler: Investigation (equal); Writing-review & editing (equal). Lukas Pfeiffer: Investigation (equal); Methodology (equal); Software (equal); Visualization (equal); Writing-review & editing (equal). Juergen Becker: Conceptualization (equal); Formal analysis (equal); Investigation (equal); Methodology (equal); Validation (equal); Visualization (equal); Writing-review & editing (equal).
Canada Man's Sandbox 