Polymorphic dermal vasculitis flare up after COVID-19: case report

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Abstract

Several types of antiviral vaccines have been developed to control the spread of the disease since COVID-19 pandemic onset. Currently, many countries are taking measures aimed at increasing vaccination rates for herd immunity formation. However, with increased number of vaccinated individuals, there are more reports of possible adverse events after vaccination, including chronic dermatoses aggravation.

The article describes a clinical case of polymorphic dermal vasculitis (hemorrhagic and urticaria types combination) flare up after COVID-19 vaccination in a 73-year-old woman, who was admitted to Department of Dermatology and Venereology (Sechenov University) with complaints of skin rashes in the trunk, upper and lower extremities and intense itching. The presence of comorbid diseases (ischemic heart disease; atrial fibrillation; chronic gastritis; diverticular colon disease; chronic kidney disease) and wide range of drugs intake on a regular basis made it difficult to diagnose. Due to appropriate therapy, clinical remission was achieved 2.5 months after treatment onset as a complete rashes regression on the trunk and upper extremities. The patient was given recommendations to maintain achieved therapeutic effect.

The “Discussion” section provides up to date statistical data on the frequency of skin reactions adverse events after various COVID-19 vaccines administration and discusses possible hypotheses for such side reactions manifestation. Recommendations are given to practicing dermatologist about possible chronic dermatoses exacerbation after vaccine administration. When deciding on vaccination, potential risks should be assessed individually and each patient should be informed accordingly. Despite developed management protocols for patients with a new coronavirus infection, treatment options are still limited. The clinical experience accumulated during the pandemic period shows that COVID-19 vaccination significantly reduces disease severity, minimizes lethal outcome and restrains pandemic outbreak. Therefore, there are no certain dermatological diseases as absolute contraindications to COVID-19 vaccination.

About the authors

Olga Olisova

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: olisovaolga@mail.ru
ORCID iD: 0000-0003-2482-1754
SPIN-code: 2500-7989

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow

Ksenia A. Vovdenko

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: vovdenkoksenia@yandex.ru
ORCID iD: 0000-0003-1415-3940
SPIN-code: 8315-2175

MD, Graduate Student

Russian Federation, Moscow

Daria V. Mak

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: bedariaaa@gamail.com
ORCID iD: 0000-0002-7020-0572
SPIN-code: 8204-4555

MD

Russian Federation, Moscow

Sergey A. Mishin

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: sergey.mischin1995@gmail.com
ORCID iD: 0000-0002-4387-3085
SPIN-code: 4644-2560

MD

Russian Federation, 8 buil., 2, Trubetskaya street, Moscow, 119991

References

  1. Robinson LB, Fu X, Hashimoto D, et al. Incidence of cutaneous reactions after messenger RNA COVID-19 Vaccines. JAMA Dermatol. 2021;157(8):1000–1002. doi: 10.1001/jamadermatol.2021.2114
  2. Hoff NP, Freise NF, Schmidt AG, et al. Delayed skin reaction after mRNA-1273 vaccine against SARS-CoV-2: a rare clinical reaction. Eur J Med Res. 2021;26(1):98. doi: 10.1186/s40001-021-00557-z
  3. McMahon DE, Amerson E, Rosenbach M, et al. Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: a registry-based study of 414 cases. J Am Acad Dermatol. 2021;85(1):46–55. doi: 10.1016/j.jaad.2021.03.092
  4. Azkur AK, Akdis M, Azkur D, et al. Immune response to SARS-CoV-2 and mechanisms of immunopathological changes in COVID-19. Allergy. 2020;75(7):1564–1581. doi: 10.1111/all.14364
  5. Vassallo C, Boveri E, Brazzelli V, et al. Cutaneous lymphocytic vasculitis after administration of COVID-19 mRNA vaccine. Dermatol Ther. 2021;34(5):e15076. doi: 10.1111/dth.15076
  6. Vojdani A, Vojdani E, Kharrazian D. Reaction of human monoclonal antibodies to SARS-CoV-2 proteins with tissue antigens: implications for autoimmune diseases. Front Immunol. 2021;11:617089. doi: 10.3389/fimmu.2020.617089
  7. Gambichler T, Scholl L, Dickel H, et al. Prompt onset of Rowell’s syndrome following the first BNT162b2 SARS-CoV-2 vaccination. J Eur Acad Dermatol Venereol. 2021;35(7):e415–e416. doi: 10.1111/jdv.17225
  8. Munguía-Calzada P, Drake-Monfort M, Armesto S, et al. Psoriasis flare after influenza vaccination in COVID-19 era: a report of four cases from a single center. Dermatol Ther. 2021;34(1):e14684. doi: 10.1111/dth.14684
  9. Krajewski PK, Matusiak Ł, Szepietowski JC. Psoriasis flare-up associated with second dose of Pfizer-BioNTech BNT16B2b2 COVID-19 mRNA vaccine. J Eur Acad Dermatol Venereol. 2021;35(10):e632–e634. doi: 10.1111/jdv.17449
  10. Onsun N, Kaya G, Işık BG, Güneş B. A generalized pustular psoriasis flare after CoronaVac COVID-19 vaccination: case report. Health Promot Perspect. 2021;11(2):261–262. doi: 10.34172/hpp.2021.32
  11. Bostan E, Gulseren D, Gokoz O. New-onset leukocytoclastic vasculitis after COVID-19 vaccine. Int J Dermatol. 2021;60(10): 1305–1306. doi: 10.1111/ijd.15777
  12. Vassallo C, Boveri E, Brazzelli V, et al. Cutaneous lymphocytic vasculitis after administration of COVID-19 mRNA vaccine. Dermatol Ther. 2021;34(5):e15076. doi: 10.1111/dth.15076
  13. Gillion V, Jadoul M, Demoulin N, et al. Granulomatous vasculitis after the AstraZeneca anti-SARS-CoV-2 vaccine. Kidney Int. 2021;100(3):706–707. doi: 10.1016/j.kint.2021.06.033
  14. Shakoor MT, Birkenbach MP, Lynch M. ANCA-associated vasculitis following Pfizer-BioNTech COVID-19 Vaccine. Am J Kidney Dis. 2021;78(4):611–613. doi: 10.1053/j.ajkd.2021.06.016
  15. Villa M, Díaz-Crespo F, Pérez de José A, et al. A case of ANCA-associated vasculitis after AZD1222 (Oxford-AstraZeneca) SARS-CoV-2 vaccination: casualty or causality? Kidney Int. 2021;100(4):937–938. doi: 10.1016/j.kint.2021.07.026
  16. Wack S, Patton T, Ferris LK. COVID-19 vaccine safety and efficacy in patients with immune-mediated inflammatory disease: review of available evidence. J Am Acad Dermatol. 2021;85(5): 1274–1284. doi: 10.1016/j.jaad.2021.07.054
  17. Wang C, Rademaker M, Tate B, et al. SARS-CoV-2 (COVID-19) vaccination in dermatology patients on immunomodulatory and biologic agents: Recommendations from the Australasian Medical Dermatology Group. Australas J Dermatol. 2021;62(2):151–156. doi: 10.1111/ajd.13593
  18. Damiani G, Allocco F; Young Dermatologists Italian Network, Malagoli P. COVID-19 vaccination and patients with psoriasis under biologics: real-life evidence on safety and effectiveness from Italian vaccinated healthcare workers. Clin Exp Dermatol. 2021;46(6):1106–1108. doi: 10.1111/ced.14631
  19. Untersmayr E, Förster-Waldl E, Bonelli M, et al. Immunologically relevant aspects of the new COVID-19 vaccines-an ÖGAI (Austrian Society for Allergology and Immunology) and AeDA (German Society for Applied Allergology) position paper. Allergo J Int. 2021;30(5): 155–168. doi: 10.1007/s40629-021-00178-2
  20. Gresham LM, Marzario B, Dutz J, Kirchhof MG. An evidence-based guide to SARS-CoV-2 vaccination of patients on immunotherapies in dermatology. J Am Acad Dermatol. 2021;84(6):1652–1666. doi: 10.1016/j.jaad.2021.01.047
  21. Ring J, Worm M, Wollenberg A, et al. Risk of severe allergic reactions to COVID-19 vaccines among patients with allergic skin diseases ― practical recommendations. A position statement of ETFAD with external experts. J Eur Acad Dermatol Venereol. 2021;35(6):e362–e365. doi: 10.1111/jdv.17237
  22. WHO Coronavirus (COVID-19) Dashboard. Available from: https://covid19.who.int/. Accessed: 15.12.2021.
  23. Beig Parikhani A, Bazaz M, Bamehr H, et al. The inclusive review on SARS-CoV-2 biology, epidemiology, diagnosis, and potential management options. Curr Microbiol. 2021;78(4):1099–1114. doi: 10.1007/s00284-021-02396-x

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2. Fig. Patient S., 73 years old, polymorphic dermal vasculitis, urticaria (a) and hemorrhagic (b) types combination.

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Copyright (c) 2022 Olisova O., Vovdenko K.A., Mak D.V., Mishin S.A.

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
 


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