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

Abstract

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 Two new unpublished cases of ours were added.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.

ANCA-associated vasculitis following Johnson and Johnson COVID-19 vaccine

“…Our patient had been immunized with Johnson and Johnson COVID-19 vaccine and developed AAV 10 days after the immunization. There have been reports of several cases of vasculitis following different COVID-19 vaccines and cases of AAV after administration of influenza vaccine [ 13 , [16] , [17] , [18] ]. So, as a lesson learnt from the past, we can speculate the neutrophilic immune response to adenovirus vector present in Johnson and Johnson vaccines, to be a potential trigger for development of AAV.…”

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

“…Skin-limited small vessel vasculitis or LCV (56) represents the most common CV reported after anti-SARS-CoV-2 vaccination. It has been observed after the Pfizer-BioNTech mRNA vaccine (BNT16B2b2) (57)(58)(59)(60)(61)(62)(63)(64)(65). Moderna mRNA 2).…”

“…IgA vasculitis ( 88 ) has been observed after vaccination with Pfizer-BioNTech mRNA vaccine (BNT16B2b2) ( 57 , 89 – 93 ), Moderna mRNA vaccine (mRNA-1273) ( 94 , 95 ), Oxford-AstraZeneca adenoviral vaccine (ChAdOx1 nCoV-19 AZD1222) ( 96 – 98 ), and Sinovac inactivated vaccine (CoronaVac) ( 99 ) ( Supplementary Table 3 ). Of note, histology was not available in all cases.…”

Immune-mediated diseases after coronavirus disease 2019 vaccination: rare but important complication

“…The autoimmune disease most commonly related to vaccination, particularly influenza vaccination, is vasculitis (7,8). The most common type of vaccine-related vasculitis is immune-mediated cutaneous vasculitis, followed by IgA vasculitis and anti-neutrophilic cytoplasmic autoantibodies (ANCA)-associated vasculitis (7,9). Shortly after the introduction of mRNA COVID-19 vaccines (Moderna or Pfizer vaccine), there have been increasing reports of mRNA vaccinesrelated immune-mediated diseases, such as vasculitides (cutaneous, IgA vasculitis, ANCA-associated, large-vessel vasculitis) as well as glomerular and other autoimmune diseases (2)(3)(4)(5)(9)(10)(11).…”

“…The most common type of vaccine-related vasculitis is immune-mediated cutaneous vasculitis, followed by IgA vasculitis and anti-neutrophilic cytoplasmic autoantibodies (ANCA)-associated vasculitis (7,9). Shortly after the introduction of mRNA COVID-19 vaccines (Moderna or Pfizer vaccine), there have been increasing reports of mRNA vaccinesrelated immune-mediated diseases, such as vasculitides (cutaneous, IgA vasculitis, ANCA-associated, large-vessel vasculitis) as well as glomerular and other autoimmune diseases (2)(3)(4)(5)(9)(10)(11). The most commonly reported glomerular disease related to COVID-19 vaccine is relapsing or de novo IgA nephropathy (IgAN), although its incidence is unknown (2,4,6).…”