Abstract
Rosai-Dorfman disease is an uncommon proliferation of non-Langerhans cell histiocytosis
that mainly affects lymph nodes, although occasionally it can be associated or even
present solely with extranodal involvement including skin and subcutaneous fat infiltration.
We present a case of cutaneous Rosai-Dorfman disease that occurred at the site of
administration of COVID-19 vaccine. The patient was a 13-year-old Bahraini girl who
presented with a 1-year history of left upper arm pain and swelling that started after
receiving the Pfizer vaccination for COVID-19. Clinically, the mass was medium-sized,
tender, and nonmobile. Ultrasound and magnetic resonance imaging were suspicious for
sarcoma. Ultrasound-guided biopsy revealed “subcutaneous panniculitis.” Excision of
the mass revealed a multinodular infiltrate of the subcutaneous fat composed of distinctive
large histiocytes, with characteristic emperipolesis, positive for S100, CD68, and
OCT-2, consistent with Rosai-Dorfman disease. We present a case of cutaneous Rosai-Dorfman
disease as a complication of COVID-19 vaccination that was challenging for the pathologist,
radiologist, and clinician.
Keywords
Rosai-Dorfman disease - COVID-19 - Pfizer vaccine - ultrasound - magnetic resonance
imaging
