Maronese Carlo Alberto, Zelin Enrico, Avallone Gianluca, Moltrasio Chiara, Romagnuolo Maurizio, Ribero Simone, Quaglino Pietro, Marzano Angelo Valerio
Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.
Front Med (Lausanne). 2022 Aug 23;9:996288. doi: 10.3389/fmed.2022.996288. eCollection 2022.
Cutaneous vasculitides encompass a heterogeneous group of clinicopathological entities, which may occur as single-organ vasculitis of the skin or present as skin-limited variant of systemic vasculitis (i.e., skin-limited ANCA-associated vasculitis), and are triggered by various factors, including infections, drugs and vaccines. The COVID-19 pandemic has challenged us with a variety of both disease- and vaccine-associated skin manifestations, including vasculitis. Among the latter, cutaneous small-vessel vasculitis, previously known as leukocytoclastic vasculitis, seems to be the most reported in either scenario, i.e., natural infection and vaccination. Vasculopathy without true vasculitic changes on histology develops in but a minority of cases, mostly severe/critical COVID-19 patients, and appears to be the result of endothelial injury due to pauci-immune thromboembolic mechanisms. Herein, we provide an overview of the available literature on COVID-19-associated and anti-SARS-CoV-2-vaccine-associated cutaneous vasculitis. Although evidence is mostly limited to isolated reports, with a proportion of cases lacking histopathological confirmation, ample overlap with pre-pandemic forms is shown.
皮肤血管炎包括一组临床病理特征各异的疾病，可表现为皮肤的单器官血管炎，或作为系统性血管炎的皮肤局限性变体（即皮肤局限性抗中性粒细胞胞浆抗体相关性血管炎）出现，并由多种因素引发，包括感染、药物和疫苗。新冠疫情给我们带来了各种与疾病和疫苗相关的皮肤表现，包括血管炎。在后者中，皮肤小血管炎，以前称为白细胞破碎性血管炎，似乎在自然感染和接种疫苗这两种情况下都是报道最多的。组织学上无真正血管炎改变的血管病变仅在少数病例中出现，大多为重症/危重症新冠患者，似乎是由寡免疫血栓栓塞机制导致的内皮损伤所致。在此，我们概述了关于新冠病毒相关和抗SARS-CoV-2疫苗相关皮肤血管炎的现有文献。尽管证据大多限于个别报道，部分病例缺乏组织病理学证实，但显示出与疫情前形式有大量重叠。
