key: cord-0932453-l4i9hyxz
authors: Erler, Anne; Fiedler, John; Koch, Anna; Schütz, Alexander; Heldmann, Frank
title: A case of leukocytoclastic vasculitis after vaccination with a SARS‐CoV2‐vaccine – a case report
date: 2021-07-01
journal: Arthritis Rheumatol
DOI: 10.1002/art.41910
sha: 1769e3634a25b9085a23b6daa1272f033a15a842
doc_id: 932453
cord_uid: l4i9hyxz

A 42‐year old caucasian woman presented herself in our ER with a one week history of rash on the lower limbs, which had first appeared 4 days after vaccination with the BioNTECH/Pfizer SARS‐CoV2 vaccine. The rash – with the typical appearance of a cutaneous small vessel vasculitis (CSVV) (figure 1) – spread from the lower limbs up to the gluteal area over a few days. Application of topical steroids had led to no improvement. Physical examination showed no other pathologies – except for hypertension and severe obesity (BMI 47).

The authors have no conflicts of interest to declare.

No funding was received. There are no financial disclosures to make.

A 42-year old caucasian woman presented herself in our ER with a one week history of rash on the lower limbs, which had first appeared 4 days after vaccination with the BioNTECH/Pfizer SARS-CoV2 vaccine. The rash -with the typical appearance of a cutaneous small vessel vasculitis (CSVV) (figure 1) -spread from the lower limbs up to the gluteal area over a few days.

Application of topical steroids had led to no improvement. Physical examination showed no other pathologies -except for hypertension and severe obesity (BMI 47).

Typical causes of CSVV (1) were considered: Concomitant medication or infection could be ruled out as possible triggers. Besides slightly elevated inflammation markers, laboratory tests were without pathological findings for C3/C4 complement, CH50, IgM, IgA, immunofixation, renal and

This article is protected by copyright. All rights reserved liver values. IgG and TSH were slightly raised (20.3 g/l and 8.3 mU/l). Imaging (chest X-ray, echocardiography and ultrasound of the abdomen) yielded normal results, as well as autoimmune serology (c/p-ANCA, rheumatoid factor, ACPA, ANA titer 1:160 with AC-4 pattern and negative ENA panel -e.g. Jo1-, U1-RNP-, Scl70-, Sm-, and Ro/La-antibodies), screening for viral infections (hepatitis B and C, CMV, EBV, Coxsackie, HIV) and cryoglobulines.

A skin biopsy from the left ankle revealed a leukocytoclastic vasculitis ( figure 2 ). An immunostaining was tried but could not be evaluated.

We started the patient on a course of prednisolone -initially 30 mg per day, which was increased to 60 mg due to poor response. With this the rash resolved over the next 5 days.

Though leukocyclastic vasculitis is idiopathic in up to 50% of the cases, due to the occurrence shortly after the vaccination we think a possible connection to the vaccine should be considered.

To our knowledge this might be the first case of the development of a leukocytoclastic vasculitis after vaccination against SARS-Cov2, whereas cutaneous small vessel vasculitis has been described due to SARS-CoV2 infection (2) and after various vaccinations -such as influenza or pneumococci (3).

Since our experience with the new COVID-19-vaccines is limited -as they have been in use for only a little more than 6 months -further investigations and observations are essential. Skin biopsy (magnification x200): a busy dermis with superficial and mid perivascular

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Dermatologic manifestations and complications of COVID-19

Leucocytoclastic vasculitis following influenza vaccination