Leukocytoclastic vasculitis after exposure to COVID-19 vaccine

Fritzen, Matheus; Funchal, Gabriella Di Giunta; Luiz, Mariana Oliveira; Steffenello‐Durigon, Giovanna

doi:10.1016/j.abd.2021.09.003

Cited by 17 publications

(17 citation statements)

References 5 publications

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“…Only one had cryoglobulinemia. 7 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 36 , 37 Nastro et al 21 reported an 84‐year‐old woman, with history of chronic kidney disease and depressive disorder, developed burning pain on the distal part of right leg and foot, followed by ipsilateral multiple non‐confluent purpuric papules and vesicles few hours after she received the first dose of Pfizer‐BioNTech COVID‐19 vaccine. PCR of a skin swab for varicella‐zoster virus (VZV) resulted positive, and VZV IgM and IgG antibodies were positive.…”

Section: Resultsmentioning

confidence: 99%

“…Twenty cases of COVID‐19‐vaccine triggered‐LCV were noted; three with an elevated anti‐Spike SARS CoV‐2 Antibody titer, two of them had no history of COVID‐19.Oral mucosal involvement was noted in one case. Only one had cryoglobulinemia 7,18–33,36,37 . Nastro et al 21 reported an 84‐year‐old woman, with history of chronic kidney disease and depressive disorder, developed burning pain on the distal part of right leg and foot, followed by ipsilateral multiple non‐confluent purpuric papules and vesicles few hours after she received the first dose of Pfizer‐BioNTech COVID‐19 vaccine.…”

Section: Resultsmentioning

confidence: 99%

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SARS‐CoV‐2 vaccination‐induced cutaneous vasculitis: Report of two new cases and literature review

Abdelmaksoud

Wollina

Temiz

et al. 2022

Dermatologic Therapy

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Currently the most powerful tool in combating the COVID‐19 pandemic is vaccination against SARS‐CoV‐2. A growing percentage of the world's population is being vaccinated. Various vaccines are worldwide on the market. Several adverse reactions have been reported as a part of post‐marketing surveillance of COVID‐19 vaccines. Among the possible adverse events, cutaneous vasculitis has occasionally been reported. We present a narrative review on cutaneous vasculitis related to COVID‐19‐vaccination to summarize clinical findings, histopathology, treatment and outcome. We searched for “COVID vaccine”, “COVID vaccination” AND “cutaneous vasculitis” in PUBMED. Articles in English have been selected, from inception to December 2021, and analyzed for patient's characteristics, type of vaccine, time of appearance of cutaneous vasculitis and clinico‐histopathologic type. Treatment and outcome have also been considered in this narrative review. Two new unpublished cases of ours were added. Cutaneous vasculitis is a rare adverse event to COVID‐19 vaccination. It has been observed with mRNA and adenovirus‐vector vaccines. IgA vasculitis, lymphocytic and ANCA‐associated vasculitis, leukocytoclastic and urticarial vasculitis have been reported. This adverse event can occur after first or second shot. Most cases run a mild to moderate course. Cornerstone of medical treatment are systemic corticosteroids. Complete remission could be achieved in most patients. Vasculitis may not be considered as a contraindication of vaccination, being uncommonly reported and shows a favorable prognosis. The benefit of the vaccination remains high especially for immunocompromised patients. COVID‐vaccine induced vasculitis is important in the differential diagnosis of purpuric and vasculitis disorders.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

SARS‐CoV‐2 vaccination‐induced cutaneous vasculitis: Report of two new cases and literature review

Abdelmaksoud

Wollina

Temiz

et al. 2022

Dermatologic Therapy

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“…The association between vaccination and development of CSVV has been reported in literature with various vaccines, namely: influenza, hepatitis A, hepatitis B, bacillus Calmette-Guérin, anthrax, human papillomavirus, measles-mumps-rubella, and pneumococcal vaccines. 25 Among the available COVID-19 vaccines, LCV has been reported with messenger RNA-based vaccines (BNT162b2 [Pfizer-BioNTech] 6,8-12 and mRNA-1273 [Moderna], 6,7 adenoviral vectorbased vaccines [ChAdOx1 nCoV-19; Oxford-AstraZeneca]), [13][14][15][16][17][18][19] and inactivated vaccines (Covaxin, 20,21 Sinovac, 22,23 and unspecified inactivated vaccines 24 ) (Table 1). Most of the reported vaccine-related cutaneous LCV were limited to the skin and only few were associated with systemic involvement.…”

Section: Discussion and Review Of Literaturementioning

confidence: 99%

“…Among the available COVID‐19 vaccines, LCV has been reported with messenger RNA‐based vaccines (BNT162b2 [Pfizer‐BioNTech] 6,8–12 and mRNA‐1273 [Moderna], 6,7 adenoviral vector‐based vaccines [ChAdOx1 nCoV‐19; Oxford‐AstraZeneca]), 13–19 and inactivated vaccines (Covaxin, 20,21 Sinovac, 22,23 and unspecified inactivated vaccines 24 ) (Table 1). Most of the reported vaccine‐related cutaneous LCV were limited to the skin and only few were associated with systemic involvement 7,9,11,19,23 .…”

Section: Discussion and Review Of Literaturementioning

confidence: 99%

Extensive cutaneous leukocytoclastic vasculitis after Sinopharm vaccine: Case report and review of the literature

et al. 2022

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“…Our patient instead maintained a normal kidney function, creatinine kinase levels were in range, and clinical examination did not find suspicious skin manifestations; it was not necessary to administer specific treatments apart from Levamisole discontinuation. Moreover, in the published case reports, only MPO antibody titers were elevated, and the mean delay between vaccination and the first symptoms was 27 days [ 22 , 23 , 24 ]. Conversely, drug-induced vasculitis is associated with increased levels of both of these antibodies in the literature.…”

Section: Discussionmentioning

confidence: 99%

Late Onset of ANCA Vasculitis as a Side Effect of Levamisole Treatment in Nephrotic Syndrome

et al. 2022

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Levamisole is effectively used in steroid-dependent nephrotic syndrome and the more frequent side effects reported are cytopenia and liver enzymes alterations. Several studies have demonstrated that this drug can induce high titers of circulating perinuclear antineutrophil cytoplasmic autoantibodies (ANCA) and vasculitis, most of them occurring in the case of prolonged use. A four-year-old boy that was affected with steroid-dependent nephrotic syndrome was treated with Levamisole as a steroid-sparing agent at a dose of 2 mg/kg/48 h. After initiation of the treatment, the number of relapses drastically decreased, enabling a significant reduction in the cumulative steroid dose. Levamisole was well tolerated, and was therefore administered for several years. At the age of 15, he was also diagnosed with celiac disease. After nine years of continuous Levamisole treatment, he presented with a high fever, hand and foot joint arthritis, and increased levels of total and direct bilirubin. Since the symptoms started two days after the injection of the second dose of the COVID-19 vaccine, it was initially concluded that these manifestations were rare vaccination side effects. Therefore, he did not receive any specific treatments, and Levamisole was continued at the same dose. After an initial improvement, two months later, the patient presented with the same symptoms. Suspecting Levamisole-induced vasculitis, an ANCA titer was measured and this returned positive. Clinical manifestations and double positivity for both myeloperoxidase (MPO) and anti-proteinase 3 (PR3) antibodies argued against the fact that that these findings were secondary to vaccination, cocaine abuse, or celiac disease. Assuming that we were facing a rare drug reaction, Levamisole was promptly interrupted. This resulted in a rapid remission of fever and arthritis improvement, and a decrease in ANCA titers. By reporting this case, we want to raise awareness among clinicians regarding a rare complication of treatment with Levamisole that is often misdiagnosed due to the fact that the current literature lacks univocal guidelines regarding the precise timing of ANCA titrations and the duration of the treatment.

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Leukocytoclastic vasculitis after exposure to COVID-19 vaccine

Cited by 17 publications

References 5 publications

SARS‐CoV‐2 vaccination‐induced cutaneous vasculitis: Report of two new cases and literature review

SARS‐CoV‐2 vaccination‐induced cutaneous vasculitis: Report of two new cases and literature review

Extensive cutaneous leukocytoclastic vasculitis after Sinopharm vaccine: Case report and review of the literature

Late Onset of ANCA Vasculitis as a Side Effect of Levamisole Treatment in Nephrotic Syndrome

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