Cutaneous vasculitis: Lessons from COVID-19 and COVID-19 vaccination

Corrà, Alberto; Verdelli, Alice; Mariotti, Elena Biancamaria; Calabria, Valentina Ruffo di; Quintarelli, Lavinia; Aimo, Cristina; Sunderkötter, Cord; Caproni, Marzia

doi:10.3389/fmed.2022.1013846

Cited by 7 publications

(12 citation statements)

References 87 publications

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“…(3) Vaccine antigens may activate B- and T-cells and cause antibody formation with subsequent immune complex deposition in small-caliber vessels. Thus, immune complex and antibody deposition can be included on vessel walls [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Henoch-Schönlein purpura following mRNA COVID-19 vaccination: a case report

Lee,

Yoo

2024

Clin Exp Vaccine Res

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The coronavirus disease 2019 (COVID-19) vaccine was developed to provide immunity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was first reported in 2019. The vaccine has proven to be effective in reducing severity and mortality and preventing infection. Henoch-Schönlein purpura is an autoimmune vasculitis (immunoglobulin A vasculitis). Historically, vaccines have been administered primarily to children, and Henoch-Schönlein purpura has often been reported in children following vaccination. However, since the start of COVID-19 vaccination, an increasing number of cases have been reported in adults. Here, we report a case of a patient who developed hematuria and proteinuria after receiving the messenger RNA COVID-19 vaccine. A 22-year-old man presented to the hospital with a lower extremity rash, bilateral ankle pain, and abdominal pain 18 days after receiving the COVID-19 vaccine. The man had no significant medical history and was not taking any medications. Laboratory tests showed normal platelet counts but elevated white blood cell counts and C-reactive protein and fibrinogen levels. He was treated with the non-steroidal anti-inflammatory drugs, pheniramine and prednisolone. At 40 days after starting treatment, C-reactive protein levels were within normal limits, and no hematuria was observed. Treatment was terminated when the purpura disappeared. This report is intended to highlight the need for further research to be proactive and carefully monitor for conditions associated with the COVID-19 vaccine.

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Section: Discussionmentioning

confidence: 99%

Henoch-Schönlein purpura following mRNA COVID-19 vaccination: a case report

Lee,

Yoo

2024

Clin Exp Vaccine Res

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“…Similar symptoms emerged among the most frequent severe adverse events subsequent to COVID-19 vaccination, at least for some of the platforms ( 144 ). For example, thrombocytopenia was mainly observed among vaccinees who received the ChAdOx1 adenoviral-vector-DNA (AstraZeneca) vaccine ( 145 , 146 ) and cutaneous vasculitis was observed mainly in those receiving ChAdOx1 ( 147 ) or the BNT162b2 mRNA (Pfizer-BioNTech) vaccine ( 148 , 149 ) (reviewed in ( 150 )). Most of the other disorders identified as severe adverse effects were reported predominantly from individuals who received the BNT162b2 vaccine, followed by mRNA-1273 (Moderna): examples include myocarditis ( 151 – 157 ), herpes zoster ( 154 , 158 – 160 ), rheumatoid arthritis ( 161 , 162 ), autoimmune nephritis or hepatitis ( 132 , 163 ), new-onset SLE ( 126 , 128 , 130 ) or neurological autoimmunity ( 164 ), and flare-ups of psoriasis ( 154 , 165 – 168 ), or SLE ( 129 , 152 , 161 , 162 , 169 ).…”

Section: Evidence From Other Pathologiesmentioning

confidence: 99%

Self-DNA driven inflammation in COVID-19 and after mRNA-based vaccination: lessons for non-COVID-19 pathologies

Heil

2024

Front. Immunol.

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The coronavirus disease 2019 (COVID-19) pandemic triggered an unprecedented concentration of economic and research efforts to generate knowledge at unequalled speed on deregulated interferon type I signalling and nuclear factor kappa light chain enhancer in B-cells (NF-κB)-driven interleukin (IL)-1β, IL-6, IL-18 secretion causing cytokine storms. The translation of the knowledge on how the resulting systemic inflammation can lead to life-threatening complications into novel treatments and vaccine technologies is underway. Nevertheless, previously existing knowledge on the role of cytoplasmatic or circulating self-DNA as a pro-inflammatory damage-associated molecular pattern (DAMP) was largely ignored. Pathologies reported ‘de novo’ for patients infected with Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV)-2 to be outcomes of self-DNA-driven inflammation in fact had been linked earlier to self-DNA in different contexts, e.g., the infection with Human Immunodeficiency Virus (HIV)-1, sterile inflammation, and autoimmune diseases. I highlight particularly how synergies with other DAMPs can render immunogenic properties to normally non-immunogenic extracellular self-DNA, and I discuss the shared features of the gp41 unit of the HIV-1 envelope protein and the SARS-CoV 2 Spike protein that enable HIV-1 and SARS-CoV-2 to interact with cell or nuclear membranes, trigger syncytia formation, inflict damage to their host’s DNA, and trigger inflammation – likely for their own benefit. These similarities motivate speculations that similar mechanisms to those driven by gp41 can explain how inflammatory self-DNA contributes to some of most frequent adverse events after vaccination with the BNT162b2 mRNA (Pfizer/BioNTech) or the mRNA-1273 (Moderna) vaccine, i.e., myocarditis, herpes zoster, rheumatoid arthritis, autoimmune nephritis or hepatitis, new-onset systemic lupus erythematosus, and flare-ups of psoriasis or lupus. The hope is to motivate a wider application of the lessons learned from the experiences with COVID-19 and the new mRNA vaccines to combat future non-COVID-19 diseases.

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“…reviewed 19 cases with histological confirmation of LV, 68.4% were male with a median age of 48.4 (range: 13–93) years; three patients had diagnosis of IgA vasculitis, five had diagnosis of urticarial vasculitis and the 11 others were considered as LV. 3 Palpable purpura (with or without necrosis and haemorrhagic blistering) was the predominant manifestation; the commonest affected areas were the lower limbs and the trunk. 3 The span of time from the COVID-19 infection to the appearance of the skin rash ranged from concomitant until more than 30 days after the first positive nasopharyngeal swab.…”

mentioning

confidence: 99%

“… 3 Palpable purpura (with or without necrosis and haemorrhagic blistering) was the predominant manifestation; the commonest affected areas were the lower limbs and the trunk. 3 The span of time from the COVID-19 infection to the appearance of the skin rash ranged from concomitant until more than 30 days after the first positive nasopharyngeal swab. It is noteworthy that the SARS-CoV-2 was found in the vessel wall in three cases by polymerase chain reaction, supporting the direct virus role in the pathogenesis of cutaneous vasculitis.…”

mentioning

confidence: 99%

“…It is noteworthy that the SARS-CoV-2 was found in the vessel wall in three cases by polymerase chain reaction, supporting the direct virus role in the pathogenesis of cutaneous vasculitis. 3 After vaccination, 39 cases had vasculitis, 61.5% were female with a mean age of 53.2 (range: 22–94) years; the predominant manifestation was purpuric papules or maculae in the lower extremities. Direct immunofluorescence was not cited in 21 cases, and in five was negative; among the remaining 13 cases, five cases were of IgA vasculitis and three of vasculitis with C3 deposition.…”

mentioning

confidence: 99%

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