Leukocytoclastic vasculitis after
            <scp>COVID</scp>
            ‐19 vaccination

Altun, Ece; Kuzucular, Elif

doi:10.1111/dth.15279

Cited by 10 publications

(9 citation statements)

References 9 publications

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“…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.…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Resultsmentioning

confidence: 99%

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

Abdelmaksoud

Wollina

Temiz

et al. 2022

Dermatologic Therapy

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Currently the most powerful tool in combating the COVID‐19 pandemic is vaccination against SARS‐CoV‐2. A growing percentage of the world's population is being vaccinated. Various vaccines are worldwide on the market. Several adverse reactions have been reported as a part of post‐marketing surveillance of COVID‐19 vaccines. Among the possible adverse events, cutaneous vasculitis has occasionally been reported. We present a narrative review on cutaneous vasculitis related to COVID‐19‐vaccination to summarize clinical findings, histopathology, treatment and outcome. We searched for “COVID vaccine”, “COVID vaccination” AND “cutaneous vasculitis” in PUBMED. Articles in English have been selected, from inception to December 2021, and analyzed for patient's characteristics, type of vaccine, time of appearance of cutaneous vasculitis and clinico‐histopathologic type. Treatment and outcome have also been considered in this narrative review. Two new unpublished cases of ours were added. Cutaneous vasculitis is a rare adverse event to COVID‐19 vaccination. It has been observed with mRNA and adenovirus‐vector vaccines. IgA vasculitis, lymphocytic and ANCA‐associated vasculitis, leukocytoclastic and urticarial vasculitis have been reported. This adverse event can occur after first or second shot. Most cases run a mild to moderate course. Cornerstone of medical treatment are systemic corticosteroids. Complete remission could be achieved in most patients. Vasculitis may not be considered as a contraindication of vaccination, being uncommonly reported and shows a favorable prognosis. The benefit of the vaccination remains high especially for immunocompromised patients. COVID‐vaccine induced vasculitis is important in the differential diagnosis of purpuric and vasculitis disorders.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

Abdelmaksoud

Wollina

Temiz

et al. 2022

Dermatologic Therapy

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“…The patients presented more severe manifestations, including massive rhabdomyolysis, necrotizing vasculitis, and acute kidney injury, and required specific treatments such as intravenous steroids, Rituximab, and cyclophosphamide. Other authors described leukocytoclastic vasculitis after exposure to a COVID-19 vaccine, presenting with purpuric lesions and palpable papules, requiring antihistamines and prednisolone [ 21 ]. Our patient instead maintained a normal kidney function, creatinine kinase levels were in range, and clinical examination did not find suspicious skin manifestations; it was not necessary to administer specific treatments apart from Levamisole discontinuation.…”

Section: Discussionmentioning

confidence: 99%

Late Onset of ANCA Vasculitis as a Side Effect of Levamisole Treatment in Nephrotic Syndrome

et al. 2022

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Levamisole is effectively used in steroid-dependent nephrotic syndrome and the more frequent side effects reported are cytopenia and liver enzymes alterations. Several studies have demonstrated that this drug can induce high titers of circulating perinuclear antineutrophil cytoplasmic autoantibodies (ANCA) and vasculitis, most of them occurring in the case of prolonged use. A four-year-old boy that was affected with steroid-dependent nephrotic syndrome was treated with Levamisole as a steroid-sparing agent at a dose of 2 mg/kg/48 h. After initiation of the treatment, the number of relapses drastically decreased, enabling a significant reduction in the cumulative steroid dose. Levamisole was well tolerated, and was therefore administered for several years. At the age of 15, he was also diagnosed with celiac disease. After nine years of continuous Levamisole treatment, he presented with a high fever, hand and foot joint arthritis, and increased levels of total and direct bilirubin. Since the symptoms started two days after the injection of the second dose of the COVID-19 vaccine, it was initially concluded that these manifestations were rare vaccination side effects. Therefore, he did not receive any specific treatments, and Levamisole was continued at the same dose. After an initial improvement, two months later, the patient presented with the same symptoms. Suspecting Levamisole-induced vasculitis, an ANCA titer was measured and this returned positive. Clinical manifestations and double positivity for both myeloperoxidase (MPO) and anti-proteinase 3 (PR3) antibodies argued against the fact that that these findings were secondary to vaccination, cocaine abuse, or celiac disease. Assuming that we were facing a rare drug reaction, Levamisole was promptly interrupted. This resulted in a rapid remission of fever and arthritis improvement, and a decrease in ANCA titers. By reporting this case, we want to raise awareness among clinicians regarding a rare complication of treatment with Levamisole that is often misdiagnosed due to the fact that the current literature lacks univocal guidelines regarding the precise timing of ANCA titrations and the duration of the treatment.

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“…Skin-limited small vessel vasculitis or LCV (56) represents the most common CV reported after anti-SARS-CoV-2 vaccination. It has been observed after the Pfizer-BioNTech mRNA vaccine (BNT16B2b2) (57)(58)(59)(60)(61)(62)(63)(64)(65). Moderna mRNA 2).…”

Section: Cutaneous Small-vessel Vasculitismentioning

confidence: 99%

Cutaneous vasculitis and vasculopathy in the era of COVID-19 pandemic

et al. 2022

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Cutaneous vasculitides encompass a heterogeneous group of clinicopathological entities, which may occur as single-organ vasculitis of the skin or present as skin-limited variant of systemic vasculitis (i.e., skin-limited ANCA-associated vasculitis), and are triggered by various factors, including infections, drugs and vaccines. The COVID-19 pandemic has challenged us with a variety of both disease- and vaccine-associated skin manifestations, including vasculitis. Among the latter, cutaneous small-vessel vasculitis, previously known as leukocytoclastic vasculitis, seems to be the most reported in either scenario, i.e., natural infection and vaccination. Vasculopathy without true vasculitic changes on histology develops in but a minority of cases, mostly severe/critical COVID-19 patients, and appears to be the result of endothelial injury due to pauci-immune thromboembolic mechanisms. Herein, we provide an overview of the available literature on COVID-19-associated and anti-SARS-CoV-2-vaccine-associated cutaneous vasculitis. Although evidence is mostly limited to isolated reports, with a proportion of cases lacking histopathological confirmation, ample overlap with pre-pandemic forms is shown.

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Leukocytoclastic vasculitis after COVID ‐19 vaccination

Cited by 10 publications

References 9 publications

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

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

Late Onset of ANCA Vasculitis as a Side Effect of Levamisole Treatment in Nephrotic Syndrome

Cutaneous vasculitis and vasculopathy in the era of COVID-19 pandemic

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