key: cord-0926817-u6k6kpjo
authors: Gázquez Aguilera, Elena María; Rodríguez García, Manuel; Cantón Yebra, María Teresa
title: Cutaneous vasculitis due to COVID-19 vaccination()
date: 2022-05-02
journal: Med Clin (Engl Ed)
DOI: 10.1016/j.medcle.2021.09.019
sha: 4e492eb38907fd60cad62721ac457dbe10a90aa4
doc_id: 926817
cord_uid: u6k6kpjo

nan

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Scientific letter An assessment was requested by the dermatology department, whose clinical impression was allergic vasculitis on the thighs and both ankles, performing a skin biopsy for diagnostic confirmation.

The anatomical pathology findings of the skin biopsy showed an epidermis with orthokeratin and no significant abnormalities. The superficial dermis showed signs of acute vascular damage, with a mild peripheral leukocyte infiltration, leukocytoclasis, blood extravasation, deposition of fibrinoid material, isolated microthrombi and prominent endothelium. No accompanying eosinophils were identified. It was associated with mild oedema of the papillary dermis, with no other findings, and without involvement of the deep dermis ( fig. 1 A and B) .

Thus, the initial diagnostic suspicion of allergic vasculitis was confirmed, and the lesions resolved with rest without the need for anti-inflammatory or steroid treatment.

The main skin reaction reported so far after administration of the Moderna vaccine was a local delayed skin reaction approximately 7 days after the first dose, in 94% of cases, with this percentage decreasing with the second dose, as well as the extent of the skin lesion. No cases of anaphylaxis or life-threatening cases were reported 23 .

Although most post-vaccination reactions are mild and limited to the site of inoculation, cases of vasculitis have been reported; in particular, allergic vasculitis following influenza vaccination in elderly patients 4 and following pneumococcus, chickenpox and hepatitis A vaccination in an immunosuppressed patient 5 .

Regarding the vaccines developed against the coronavirus, no cases of vasculitis have yet been described after administration, but hypersensitivity with cutaneous vasculitis developed after the above-mentioned vaccines reinforces the role of vaccination against SARS-CoV-2 as a trigger for vasculitis.

The case described was reported to pharmacovigilance because of its temporal relationship with the SARS-CoV-2 vaccination, as it occurred 11 days after the inoculation of the second dose of Moderna.

SARS-CoV-2 vaccines can potentially precipitate cutaneous vasculitis, although well-designed and methodologically sound trials are needed to draw a definitive conclusion.

This research has not received any grants. 

A. Hallazgos histopatológicos en biopsia cutánea con tinción hematoxilina-eosina.

B. Hallazgos histopatológicos en biopsia cutánea con PAS.

Depósito de material fibrinoide, microtrombos aislados y endotelios prominentes.

Infiltrado leucocitario con leucocitoclasia y extravasación hemática.

C. Vasculitis Leucocitoclástica. * Lesiones cutáneas compatibles con púrpura palpable.

SARS-CoV-2 vaccine candidates in rapid development

Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: A registry-based study of 414 cases

Delayed Localized Hypersensitivity Reactions to the Moderna COVID-19 Vaccine: A Case Series

Leucocytoclastic vasculitis following influenza vaccination

Leukocytoclastic vasculitis after vaccination in a patient with inflammatory bowel disease