Granulomatous dermatitis post Mycobacterium Indicus Pranii (MIP) vaccine in severe covid-19 infection: an exaggerated hypersensitivity phenomenon

Abstract

Mycobacterium indicus pranii (MIP) vaccine is widely used in dermatology as immunotherapy for warts as well as in patients with leprosy. During the COVID-19 pandemic, a positive role of MIP as an immunomodulator in SARS-CoV-2 disease was reported after pilot research, with minor adverse effects. We report a case of a 65-year-old male, presenting with skin lesions suggestive of noninfective granulomatous dermatitis for 4 months, at the sites of MIP intradermal injections, allegedly received during a hospital stay for severe COVID-19 disease. The patient presented with nonhealing nodulo-ulcerative lesions at the sites of injection, which persisted for 4 months associated with intermittent serous discharge and showed no signs of healing despite supportive treatment. The patient was started on a combination therapy of ofloxacin 400 mg /day and clarithromycin 500 mg 12 hourly for 2 months. At the end of 2 months, all the lesions showed complete healing with a resolution of discharge and nodularity, leaving behind postinflammatory hypopigmentation and atrophic scarring. The patient was followed up for 4 months after stopping treatment during which time he had no relapse of the lesions. This case has been reported to the India Pharmacopoeia.