Cutaneous vasculitis and vasculopathy in the era of COVID-19 pandemic

Abstract

Cutaneous vasculitides encompass a heterogeneous group of clinicopathological entities, which may occur as single-organ vasculitis of the skin or present as skin-limited variant of systemic vasculitis (i.e., skin-limited ANCA-associated vasculitis), and are triggered by various factors, including infections, drugs and vaccines. The COVID-19 pandemic has challenged us with a variety of both disease- and vaccine-associated skin manifestations, including vasculitis. Among the latter, cutaneous small-vessel vasculitis, previously known as leukocytoclastic vasculitis, seems to be the most reported in either scenario, i.e., natural infection and vaccination. Vasculopathy without true vasculitic changes on histology develops in but a minority of cases, mostly severe/critical COVID-19 patients, and appears to be the result of endothelial injury due to pauci-immune thromboembolic mechanisms. Herein, we provide an overview of the available literature on COVID-19-associated and anti-SARS-CoV-2-vaccine-associated cutaneous vasculitis. Although evidence is mostly limited to isolated reports, with a proportion of cases lacking histopathological confirmation, ample overlap with pre-pandemic forms is shown.

Association of the Monocyte-to-High-Density Lipoprotein Cholesterol Ratio with Gastrointestinal Involvement of Immunoglobulin a Vasculitis

“… 2–4 Genetic factors, both abnormal innate and acquired immunity, inflammation, galactose-deficient IgA1 immunocomplexes, COVID-19 as well as anti-COVID vaccines are considered to be involved in the pathogenesis of IgAV. 11 , 16 Endothelial cells distribute on the inner surfaces of blood vessels as well as lymphatic vessels. They have proven to play a crucial role in the metabolism and endocrine function and they are also the primary targets of external stimuli and endogenous immune activity.…”

New Onset of Giant Cell Arteritis following ChAdOx1-S (Vaxevria®) Vaccine Administration

“…A similar mechanism involving the anaphylatoxins and inducing excessive mastocyte activation was hypothesized on the basis of the development of urticarial vasculitis. Some patients developed severe COVID-19, characterized by indirect endothelial injury, due to elevated proinflammatory cytokines and ischemia-induced complement activation [ 9 ].…”

Cutaneous vasculitis after COVID-19 vaccination in a 41-year-old male

“…Culprit vaccines are influenza, BCG, human papillomavirus, and hepatitis B vaccines [2]. CV has been associated with both Coronavirus disease-2019 (COVID-19), and SARS-CoV-2 vaccines [3,4]. The inflammatory response triggered by the vaccine, and immune complex deposition within the vessels wall of the dermis have been described as the cause of this adverse event.…”