Clinic of Allergy and Immunology, University Clinical Centre of Serbia, Koste Todorovica 2, 11000, Belgrade, Serbia.
Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000, Belgrade, Serbia.
Rheumatol Int. 2024 Nov;44(11):2621-2635. doi: 10.1007/s00296-024-05718-x. Epub 2024 Sep 16.
With the global introduction and widespread administration of COVID-19 vaccines, there have been emerging reports of associated vasculitis, including leukocytoclastic cutaneous vasculitis (LCV). In this paper, we present a case of a 68-year-old female patient who developed painful purpuric skin lesions on her feet 12 days after administration of the inactivated COVID-19 vaccine BBIBP Cor-V with histopathological confirmation of LCV and no signs of systemic involvement. The case is followed by a comprehensive literature review of documented LCV cases associated with COVID-19 vaccination with overall 39 articles and 48 cases of LCV found in total. In the majority of cases (56.3%) the first symptom occurred after the first dose of the COVID-19 vaccine, with symptoms manifesting within an average of seven days (6.8 ± 4.8) post-vaccination. The adenoviral vaccine Oxford-AstraZeneca (41.7%) and the mRNA vaccine Pfizer-BioNTech (27.1%) were most frequently associated with LCV occurrences. On average, LCV resolved within 2.5 (± 1.5) weeks. The preferred treatment modality were glucocorticoids, used in 70.8% of cases, resulting in a positive outcome in most cases, including our patient. While the safety of a subsequent dose appears favorable based on our review, individual risk-benefit assessment is crucial. This review emphasis the importance of considering COVID-19 vaccination as a potential trigger for the development of cutaneous vasculitis. Despite rare adverse events, the benefits of the COVID-19 vaccination outweigh the risks, highlighting the importance of immunization programs.
随着全球范围内 COVID-19 疫苗的引入和广泛应用，出现了与疫苗相关的血管炎的报告，包括白细胞碎裂性皮肤血管炎（LCV）。本文报告了一例 68 岁女性患者，在接种灭活型 COVID-19 疫苗 BBIBP Cor-V 后 12 天，足部出现疼痛性紫癜性皮肤损伤，组织病理学证实为 LCV，且无全身受累的迹象。该病例后附有与 COVID-19 疫苗接种相关的 LCV 病例的全面文献复习，共收录了 39 篇文献和 48 例 LCV 病例。在大多数病例（56.3%）中，首发症状出现在 COVID-19 疫苗第一剂后，症状平均在接种后 7 天（6.8±4.8）出现。腺病毒疫苗 Oxford-AstraZeneca（41.7%）和 mRNA 疫苗 Pfizer-BioNTech（27.1%）与 LCV 发生的关联最为频繁。平均而言，LCV 在 2.5（±1.5）周内缓解。首选的治疗方式为糖皮质激素，在 70.8%的病例中使用，大多数病例（包括我们的患者）均取得了良好的疗效。尽管根据我们的回顾，后续接种的安全性似乎较好，但仍需进行个体化的风险-获益评估。该综述强调了将 COVID-19 疫苗接种视为皮肤血管炎发展的潜在触发因素的重要性。尽管罕见发生不良反应，但 COVID-19 疫苗接种的益处大于风险，突显了免疫接种计划的重要性。
