Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts.
J Emerg Med. 2022 Aug;63(2):e62-e65. doi: 10.1016/j.jemermed.2021.10.005. Epub 2021 Oct 23.
Although vaccination against coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been proven generally safe, rare but potentially serious adverse reactions do occur. Leukocytoclastic vasculitis (LCV) is a small-vessel vasculitis that has been associated with other immunizations, but, to our knowledge, has not been previously reported in association with vaccines directed against SARS-CoV-2.
We report the case of a 22-year-old man with no known past medical history who presented to the Emergency Department with 2 days of migratory arthritis in his ankles and palpable purpura on his bilateral lower extremities, occurring 10 days after receiving the Johnson & Johnson SARS-CoV-2 vaccine. The patient's clinical presentation was suggestive of leukocytoclastic vasculitis, and this diagnosis was confirmed on skin biopsy. Why Should an Emergency Physician Be Aware of This? Recognition of vasculitides is important for timely treatment and prevention of complications. In a patient presenting with palpable purpura after immunization against SARS-CoV-2, LCV should be promptly considered and worked up by the Emergency Physician, though management is most often entirely outpatient and the clinical course is typically mild and self-resolving.
尽管针对严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）的冠状病毒疫苗已被证明总体上是安全的，但确实会发生罕见但潜在严重的不良反应。白细胞碎裂性血管炎（LCV）是一种小血管血管炎，与其他疫苗接种有关，但据我们所知，以前尚未与针对 SARS-CoV-2 的疫苗有关。
我们报告了一例 22 岁的男性病例，无已知既往病史，在接种强生 SARS-CoV-2 疫苗 10 天后出现 2 天游走性踝关节关节炎和双侧下肢可触及性紫癜。患者的临床表现提示白细胞碎裂性血管炎，皮肤活检证实了这一诊断。为什么急诊医生应该了解这一点？识别血管炎对于及时治疗和预防并发症很重要。对于接种 SARS-CoV-2 疫苗后出现可触及性紫癜的患者，急诊医生应立即考虑并进行白细胞碎裂性血管炎检查，尽管大多数情况下治疗完全是门诊，且临床病程通常较轻并自行缓解。
