Images in Vascular Medicine: Leukocytoclastic vasculitis after COVID-19 vaccine booster

Abstract

A 65-year-old man developed purpuric palpable lesions of the legs 2 days after receiving his third dose (booster) of Pfizer BioNTech vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Panels A and B). He received his initial vaccinations 4 months prior to receiving his booster injection. He denied any prior SARS-CoV-2 infection. He denied any systemic symptoms. The patient has a history of diabetes and hypertension for which he is on metformin and lisinopril, respectively; he otherwise has no other medical problems. Punch biopsy of the leg showed neutrophilic inflammation with fibrinoid necrosis and fragmented neutrophilic nuclei (leukocytoclasis), consistent with leukocytoclastic vasculitis (LCV). He was treated with one dose of triamcinolone 60 mg (IM), oral prednisone (tapered from 60 mg/d to 10 mg/d), along with topical clobetasol propionate and mupirocin.LCV is a cutaneous, small-vessel vasculitis characterized by deposition of immune complexes in the dermal capillaries and venules. 1 Half of all cases of LCV are idiopathic; among secondary LCV, infections and medications are the most common triggers. Numerous medications have been implicated, including several antibiotics, furosemide, allopurinol, nonsteroidal antiinflammatory drugs (NSAIDs), amiodarone, metformin, warfarin, and several vaccines, including the influenza, hepatitis B (HBV), Bacille Calmette-Guérin (BCG), and human papillomavirus (HPV) vaccines. 2 Most cases of cutaneous LCV are mild and resolve with supportive measures; if LCV is more chronic or resistant, oral corticosteroids can be used. For medication-induced LCV, withdrawal of the drug is crucial for resolution.With the mass vaccination effort to address the coronavirus disease 2019 (COVID-19) pandemic caused by the SARS-CoV-2, there have been numerous reports of cutaneous manifestations after receiving the SARS-CoV-2 vaccine, including those manufactured by Moderna, Pfizer BioNTech, and Johnson & Johnson. The most commonly reported cutaneous manifestations are vaccine-related eruption of papules and plaques (V-REPP), bullous pemphigoid-like, dermal hypersensitivity reactions, herpes zoster, lichen planus-like, and pernio. 3 There have been case reports of the development of LCV after the Moderna and Pfizer BioNTech SARS-CoV-2 vaccines; however, there have been no other reported cases of LCV development after the SARS-CoV-2 booster vaccine. [3][4][5] The mechanism of SARS-CoV-2 vaccine-induced

SARS‐CoV‐2 vaccination‐induced cutaneous vasculitis: Report of two new cases and literature review

“…Only one had cryoglobulinemia. 7 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 36 , 37 Nastro et al 21 reported an 84‐year‐old woman, with history of chronic kidney disease and depressive disorder, developed burning pain on the distal part of right leg and foot, followed by ipsilateral multiple non‐confluent purpuric papules and vesicles few hours after she received the first dose of Pfizer‐BioNTech COVID‐19 vaccine. PCR of a skin swab for varicella‐zoster virus (VZV) resulted positive, and VZV IgM and IgG antibodies were positive.…”

“…Twenty cases of COVID‐19‐vaccine triggered‐LCV were noted; three with an elevated anti‐Spike SARS CoV‐2 Antibody titer, two of them had no history of COVID‐19.Oral mucosal involvement was noted in one case. Only one had cryoglobulinemia 7,18–33,36,37 . Nastro et al 21 reported an 84‐year‐old woman, with history of chronic kidney disease and depressive disorder, developed burning pain on the distal part of right leg and foot, followed by ipsilateral multiple non‐confluent purpuric papules and vesicles few hours after she received the first dose of Pfizer‐BioNTech COVID‐19 vaccine.…”

Extensive cutaneous leukocytoclastic vasculitis after Sinopharm vaccine: Case report and review of the literature

“…Among the available COVID‐19 vaccines, LCV has been reported with messenger RNA‐based vaccines (BNT162b2 [Pfizer‐BioNTech] 6,8–12 and mRNA‐1273 [Moderna], 6,7 adenoviral vector‐based vaccines [ChAdOx1 nCoV‐19; Oxford‐AstraZeneca]), 13–19 and inactivated vaccines (Covaxin, 20,21 Sinovac, 22,23 and unspecified inactivated vaccines 24 ) (Table 1). Most of the reported vaccine‐related cutaneous LCV were limited to the skin and only few were associated with systemic involvement 7,9,11,19,23 .…”

Drug induced vasculitis , Thiazide or COVID-vaccine ? : A case report and literature review

“…Another potential cause for the occurrence of vasculitis is the use of thiazides, which has been known for many years (1) .Although our patient received a low dose of hydrochlorthiazide (HCTZ) (25mg once daily ), drug induced vasculitis due to HCTZ could not be ruled out . Finally, we were curious whether the administration of COVID vaccines could result in vasculitis .Although there have recently been some reports about the use of mRNA based COVID vaccines as a cause of leukocytoclastic vasculitis (8)(9)(10)(11)(12) , the role of inactivated whole virus vaccines such as Sinopharm , Sinovac (CoronaVac) and COVAXIN (Bharat Biotech) should not be overlooked (13)(14)(15) .…”