key: cord-0867635-sqm9q1v3
authors: Liang, Ian; Swaminathan, Sanjay; Lee, Adrian Y. S.
title: Emergence of de novo cutaneous vasculitis post coronavirus disease (COVID-19) vaccination
date: 2021-10-02
journal: Clin Rheumatol
DOI: 10.1007/s10067-021-05948-5
sha: 40824645db93e368886371737360c927ac2a2ea6
doc_id: 867635
cord_uid: sqm9q1v3

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nuclear antigen antibodies, no anti-neutrophil cytoplasmic antibodies (ANCA), and raised rheumatoid factor (169 IU/ mL [< 20]) with depressed C4 complement (< 0.07 g/L). Cryoglobulins and anti-cyclic citrullinated peptide antibodies were not detected. An infectious screen including hepatitis and syphilis serologies was unremarkable.

A CT pulmonary angiogram did not reveal pulmonary emboli, and an MRI brain venogram did not demonstrate a cerebral sinus venous thrombosis. Skin punch biopsies revealed perivascular acute inflammation ( Fig. 1B) with C3 and fibrinogen deposition in the superficial dermal vessels on immunofluorescence microscopy (Fig. 1C, D) , consistent with a leukocytoclastic vasculitis. The patient was commenced on a rapid tapering course of oral prednisolone to good resolution and improvement in her symptoms, rash, and pathology tests. No underlying systemic autoimmune disease was established.

There have been numerous reports in literature where vaccines such as the influenza and the Bacille Calmette-Guerin vaccines have resulted in vasculitis as an adverse reaction [1] . Reports also exist where the COVID-19 vaccination has caused a flare of pre-existing leukocytoclastic vasculitis [2] and the development of IgA vasculitis in a patient with prior COVID-19 illness [3] . The exact aetiology of postvaccination vasculitis is unknown, but risk factors include genetic, immunological, hormonal, and environmental factors [4] . Whilst the vaccine was certainly contributory to the development of vasculitis in this patient, it is possible that it was triggered in an already immunologically predisposed individual [5] . It is therefore important that clinicians are aware that vasculitis can be a possible adverse reaction to the ChAdOx1 nCoV-19 vaccine, both de novo and pre-existing.

Author contribution IL contributed to the manuscript draft, concept design, data acquisition and analysis, and clinical care of the patient. SS contributed to the manuscript draft, concept design, supervision, and clinical care of the patient. AL contributed to the manuscript draft, concept design data acquisition and analysis, and clinical care of the patient. All authors have contributed to revising the manuscript critically for intellectual content.

Ethics approval and consent to participate Written informed consent was obtained from the patient for publication of this case report and any accompanying images.

Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 

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