key: cord-0686126-v1a1w6y4
authors: Fritzen, Matheus; Funchal, Gabriella Di Giunta; Luiz, Mariana Oliveira; Durigon, Giovanna Steffenello
title: Leukocytoclastic vasculitis after exposure to COVID-19 vaccine
date: 2021-11-10
journal: An Bras Dermatol
DOI: 10.1016/j.abd.2021.09.003
sha: 7f97ebaabf64f1fde57be3c0d88c45efc8fc501d
doc_id: 686126
cord_uid: v1a1w6y4

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Section of a University Hospital reporting the appearance of painful purpuric lesions in the lower limbs three days before. She denied fever, chills, arthralgia, or trauma. She denied the use of new medications. She reported receiving the second dose of the COVID-19 vaccine (Oxford-AstraZeneca) approximately eleven days before. She denied a similar previous clinical picture.

On physical examination, she had purpuric lesions and palpable papules, which did not disappear on digital pressure ( Figs. 1 and 2 ).

She reported daily use of propranolol, metformin and levothyroxine. She described stability of the polycythemia vera since December 2015. She was submitted to two lower-limb skin punch biopsies for histopathological analysis and immunofluorescence (IF). Prednisone (1 mg/kg/day) was started once a day. The histopathological examination showed a mixed inflammatory infiltrate with predominantly perivascular fragmented neutrophils associated with extravasated red blood cells (Fig. 3 a-c) . IF showed deposits of IgA and IgM on the walls of postcapillary vessels (Fig. 3d ). The histological picture was compatible with leukocytoclastic vasculitis. The patient denied symptoms or a previous clinical picture of COVID-19. The possibility of cryoglobulinemia was suggested, and serum cryoglobulins were measured, which were negative. She had elevated C-reactive protein levels and leukocytosis with a leftward shift.

The remaining blood count results, liver function, coagulogram, and partial urine tests were within the normal limits or compatible with the comorbidities (Table 1) . After three days of hospitalization, she showed improvement of the lower limb lesions and painful symptoms. After a seven-day treatment with 60 mg prednisone, a progressive reduction was started, and she was discharged from the hospital on 40 mg/day of prednisone.

Immunization is a highly important resource in the fight against pandemics, especially the current one caused by COVID-19. However, possible side effects have not yet been fully 

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