Leukocytoclastic vasculitis (cutaneous small-vessel vasculitis) after COVID-19 vaccination

• Published in: Journal of autoimmunity Vol. 127; p. 102783
• Main Authors: Fiorillo, G., Pancetti, S., Cortese, A., Toso, F., Manara, S., Costanzo, A., Borroni, R.G.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-02-2022
• Subjects: Aged; COVID-19 vaccine; COVID-19 Vaccines - adverse effects; Cutaneous small-vessel vasculitis; Female; Humans; Leukocytoclastic vasculitis; Neutrophil Infiltration; Prednisone - therapeutic use; SARS-CoV-2 vaccine; Vaccines adverse reactions; Vasculitis, Leukocytoclastic, Cutaneous - blood; Vasculitis, Leukocytoclastic, Cutaneous - drug therapy; Vasculitis, Leukocytoclastic, Cutaneous - etiology; Vasculitis, Leukocytoclastic, Cutaneous - pathology; Vaxzevria vaccine; Leukocytoclastic vasculitis; COVID-19 vaccine; SARS-CoV-2 vaccine; Cutaneous small-vessel vasculitis; Vaxzevria vaccine; Vaccines adverse reactions
• DOI: 10.1016/j.jaut.2021.102783
• EISSN: 1095-9157
• ISSN: 0896-8411

Vaccinations may induce cutaneous adverse events, due to nonspecific inflammation or immuno-mediated reactions. Several types of vasculitis have been observed. We report on a 71-year-old woman who developed cutaneous small-vessel vasculitis after the second dose of Vaxzevria COVID-19 vaccination, showing leukocytoclastic vasculitis on histopathological examination of a skin biopsy.
Cutaneous small-vessel vasculitis is a rare condition which can be idiopathic or secondary to underlying infections, connective tissue disorders, malignancy, and medications. The pathogenesis involves immune complex deposition in small blood vessels, leading to activation of the complement system and recruitment of leukocytes.
Exacerbation of small-vessel vasculitis has been reported following the administration of various vaccines, particularly influenza vaccine. It is expected that SARS-CoV-2 vaccine results in the activation of B- and T-cells and antibody formation. We hypothesize that leukocytoclastic vasculitis caused by immune complex deposition within cutaneous small vessels could be a rare side effect of Vaxzevria COVID‐19 vaccination.
•Vasculitis precipitation has been reported secondary to different vaccines.•A 71-year-old woman developed cutaneous vasculitis after receiving COVID-19 vaccine.•COVID-19 vaccine might result in immune complex deposition within small vessels.•Leukocytoclastic vasculitis might be an adverse reaction to COVID-19 vaccination.