{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T09:58:23Z","timestamp":1785491903289,"version":"3.56.0"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,31]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Vaccine-related mucocutaneous reactions are usually mild, with atypical presentations and superinfections that can mimic soft-tissue emergencies. A previously healthy 19-year-old man developed isolated lower-lip oedema 3\u20134\u2005h after an mRNA COVID-19 booster, peaking at 96\u2005h. Initial blood test results were unremarkable, and angioedema therapy (antihistamines and a short course of corticosteroid) was ineffective. On day 12, he re-presented with marked swelling and necrotic slough but no systemic toxicity [Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score of 4]. Debridement and histopathology showed mixed neutrophilic and lymphohistiocytic inflammation extending into skeletal muscle. Wound culture grew methicillin-resistant Staphylococcus aureus (MRSA), and a course of co-trimoxazole led to rapid resolution. The chronology, histopathology and treatment response support delayed-type hypersensitivity temporally associated with vaccination, complicated by MRSA impetiginization that mimicked necrotizing fasciitis. In orofacial presentations, LRINEC has limited sensitivity; hence, clinical correlation and early surgical input are pivotal. We outline a pragmatic approach: consider recent vaccination(s) in rapid-onset mucosal swelling, obtain early cultures, escalate to anti-MRSA therapy if deterioration occurs and involve surgical teams promptly\u00a0when necrosis or functional compromise is present. Persistent isolated labial oedema after mRNA vaccination may additionally\u00a0reflect non-IgE delayed hypersensitivity with potential for bacterial superinfection.<\/jats:p>","DOI":"10.1093\/skinhd\/vzag074","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T11:44:39Z","timestamp":1780573479000},"page":"600-604","source":"Crossref","is-referenced-by-count":0,"title":["Progressive isolated lower-lip oedema after mRNA COVID-19 booster complicated by methicillin-resistant\n                    <i>Staphylococcus aureus<\/i>\n                    superinfection: a necrotizing fasciitis mimic"],"prefix":"10.1093","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0750-4522","authenticated-orcid":false,"given":"Tristen Tze Wei","family":"Ng","sequence":"first","affiliation":[{"name":"Department of Dermatology, Royal Perth Hospital , Perth, WA ,","place":["Australia"]},{"name":"UWA Medical School, The University of Western Australia , Crawley, WA ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda Marie","family":"Tillmann","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Royal Perth Hospital , Perth, WA ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Frank","family":"Iacobelli","sequence":"additional","affiliation":[{"name":"Department of Dermatopathology, PathWest Laboratory Medicine , Nedlands, WA ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas Anthony","family":"Delaney","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Royal Perth Hospital , Perth, WA ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,15]]},"reference":[{"key":"2026073105090675300_vzag074-B1","doi-asserted-by":"crossref","DOI":"10.1080\/21645515.2023.2253589","article-title":"Oral 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