With the present COVID‐19 vaccination drive across the world, adverse skin reactions post COVID‐19 vaccine is expected. Majority of these reactions seen were transient or local injection site reactions. However, as the larger population is being vaccinated, certain uncommon dermatological presentations including leukocytoclastic vasculitis, pityriasis rosea, and exacerbation of pre‐existing autoimmune diseases are now being reported. Among all the COVID‐19 vaccines, most of these reactions are seen with messenger ribonucleic acid‐based Pfizer/BioNTech (BNT162b2) and Moderna (mRNA‐1273) vaccine. We report two cases of leukocytoclastic vasculitis following ChAdOx1 nCoV‐19 corona virus vaccine (recombinant) that bring out potential new dermatological manifestations of recombinant corona virus vaccine being administered across the European, South American, and Asian countries. It is important for all health care workers and patients to be aware of the corona virus vaccine associated adverse cutaneous reactions.

Background Tuberculosis is a chronic granulomatous disease and an enormous health problem. Oral lesions are relatively uncommon, however, pulmonary tuberculosis may manifest with the involvement of the gingiva as the only primary finding.Case description The present case study reports tuberculosis of the gingiva manifesting as gingival enlargement. The diagnosis was based on sputum examination, histopathology and immunologic investigations. Anti-tubercular therapy was carried out with remarkable changes in gingival health within four months.Clinical implications and conclusion Gingival tuberculosis is a relatively uncommon occurrence and this case study emphasises the need for the clinician to include tuberculosis in the differential diagnosis of various types of gingival enlargement. Early detection and prompt treatment is the key for management of this highly infectious and communicable disease.

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a 22 years male developed fever, pain abdomen, vomiting, and painful swelling of both ankle and wrist joints. Two days later, he noticed multiple red raised lesions symmetrically over all extremeries. Nasopharyneal swab for Coronavirus disease 2019 (COVID-19) PCR testing was positive at admission. He had no respiratory symptoms. Examination revealed fever (100.8 F), edema with tenderness over both wrist, hand and ankle joints. Cutaneous examination revealed multiple, discrete to confluent palpable purpura with few central vesicles distributed symmetrically over all extremities, gluteal region, and lower abdomen (Figure 1A-D). He denied history of any drug intake prior to onset of symptoms.The patient was investigated on the lines of IgA vasculitis and systemic involvement of COVID-19. Urinalysis revealed a proteinuria of 2 g/day. Remaining investigations were as in Table 1. Skin biopsy from thigh lesion revealed features of leukocytoclastic vasculitis (Figure 2A,B). Direct immunofluorescence (DIF) from lesion was negative which could be due to biopsy from a lesion >48 h duration or sample processing error. PCR for SARS-CoV-2 from skin sample could not be done due to nonavailability. Because of the proteinuria, a kidney biopsy was done which showed features of focal necrotizing, mesangial, and focal endocapillary proliferative IgA nephropathy with mesangial granular deposits of IgA (Figure 3). Patient was promptly started on injection dexamethasone equivalent to 1 mg/kg of prednisolone for 10 days and shifted to oral prednisolone subsequently. Presence of poor prognostic findings on kidney biopsy with glomerular segmental tuft necrosis and cellular crescent formation prompted us to plan long-term immunosuppressants for at least three months duration. Hence, mycophenolate mofetil as steroid sparing agent was added to be continued for three months and oral prednisolone tapered off in one month. His cutaneous lesions, joint involvement and abdominal symptoms resolved, liver function tests, and urinalysis normalized over 2 weeks. The patient is under follow-up to look for long-term renal complications.

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