Leukocytoclastic vasculitis after the third dose of CoronaVac vaccination

 Two weeks after receiving the third injection of the CoronaVac COVID-19 vaccine, a 77-year-old male with eruptive skin lesions was admitted to a clinic in Turkey. He complained of arthralgia, myalgia, and general fatigue and also experienced intestinal symptoms such as bloody diarrhea and abdominal pain. He reported a mildly itchy rash with his first (5 month prior) and second (4 month prior) immunizations, without fever, difficulty breathing, edema, oliguria, or other systemic symptoms. 

Dermatologic examination revealed diffuse palpable, tender, non-blanching violaceous coalescent patches on the thighs, calves, feet, and hands. There were also bullous hemorrhagic lesions distributed bilaterally on the extensor sides of the lower legs and feet. 

Pathologic laboratory testing revealed elevated C-reactive protein levels of 60 mg/L (normal: 6). D-dimer values and other tests were normal. Autoimmune workup revealed no pathologic findings. Screenings for viral infections including COVID-019 were negative. 

He was treated with oral prednisolone at a dose of 0.5 mg/kg/day. At a follow-up 14 days later, all clinical manifestations and laboratory findings were resolved.

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REFERENCE

Oskay T, Isık M. Leukocytoclastic vasculitis after the third dose of CoronaVac vaccination. Clinical rheumatology. 2021 Dec 1:1-3.

Multiple cutaneous adverse drug reactions (CADR), also known as toxidermia have been described after COVID-19 vaccines. Examples are generalized morphea involving multiple anatomical regions with erythematous and sclerotic plaques or brownish patches all over the body, after the second dose of the BNT162b2 COVID-19 vaccine.


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