A case of cutaneous vasculitis following third dose of SARS-CoV-2 vaccine in an immunocompromised patient

A 58-year-old man known to dermatology services, established on guselkumab for psoriasis and methotrexate for psoriatic arthritis, attended with an acute onset purpuric rash distributed over both his lower limbs, one day after his third dose of SARS-CoV-2 Pfizer-BioNTech vaccine (booster). He had received his initial vaccinations 6 months prior with no reported reactions. He denied any previous SARS-CoV-2 infection or recent symptoms suggestive of COVID-19. There had been no new recent medications and no systemic symptoms were reported. Examination revealed a nonblanching, palpable, purpuric rash distributed over both lower limbs, clinically in keeping with cutaneous vasculitis. Baseline observations were satisfactory including blood pressure and temperature. Bedside investigations included a urinalysis which revealed no proteinuria or haematuria. Punch biopsies were taken and were consistent with a leucocytoclastic vasculitis (LCV). He was managed symptomatically with potent topical steroids with good clinical response. LCV is classified as a cutaneous, small vessel vasculitis, exclusively characterized by deposition of immune complexes in the dermal capillaries and venules (Baigrie D, Bansal P, Goyal A, Crane JS. Leukocytoclastic vasculitis. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing, 2021). LCV following both first and second SARS-CoV-2 vaccinations has been documented in recent literature with a few reports following a third booster dose, and in particular within an immunocompromised population. This particular case has raised questions regarding delayed immune response following SARS-CoV-2 vaccine in this subgroup. The pathophysiology of SARS-CoV-2 vaccine-induced LCV has not been extensively researched;however, it is felt to be caused by offtarget immune activation after the vaccination (Dicks AB, Gray BH. Images in vascular medicine: leukocytoclastic vasculitis after COVID-19 vaccine booster. Vasc Med 2022;27: 100-1).

STING. steroid injections during covid-19. a cross speciality call

Introduction: An important clinical question during the Covid-19 pandemic is the safety of steroid use. Guidelines published by rheumatology, physiotherapy, orthopaedic and pain medicine societies have advised on the restricted use of corticosteroids for musculoskeletal and rheumatic conditions. For clinicians across the specialities there is a challenge to safely conducting best practice, yet ensuring patients have access to the significant functional benefits of steroid injections. Methods: The STING prospective service evaluation will collect data on steroid injections undertaken during this part of the pandemic. Clinicians will be able to input information on patient demographics, background Covid risk and steroid injection specifics. At follow up at 4-6 weeks complications and Covid specific outcomes will be recorded, as well as patient perceived symptom improvement. Each unit collecting data will have assigned collaborator(s), with a senior consultant validating the data. Data will be collected and managed using Research Electronic Data Capture (REDCap). Data collection and management will adhere to Caldicott II principles and GDPR. Results: Results will be analysed through RedCap and compared to national Covid incidence. Local complication and patient reported outcomes will be compared between specialities, environments and steroid specifics (volume, location etc.). Conclusion: A pan-speciality look at steroid injection use during the pandemic will be useful primarily to contribute to understanding the safety of steroid use. Secondarily to look at cross speciality differences in administration, PROMs and to appreciate patient groups who may be excluded from steroid treatment.

De novo generalized pustular psoriasis following Oxford-AstraZeneca COVID-19 vaccine.

We present an interesting and novel case of a de novo generalized pustular psoriasis following administration of first dose of Oxford-AstraZeneca COVID-19 vaccine in a patient with no pre-existing psoriasis or any previous dermatological issue.

Urological surgery during the covid-19 pandemic

Aims Peri-operative SARS-CoV-2 infection is of particular concern for surgeons and their patients due to the high morbidity and mortality. In this study, we investigate the effectiveness of pre-operative SARS-CoV-2 screening in preventing peri-operative infections in a region with a low incidence of infection. Methods Data was collected prospectively on all patients who underwent urological surgery after the exponential phase of the pandemic. The primary outcome was the development of SARS-CoV-2 infection in patients. The secondary outcome was SARS-CoV-2 infections in healthcare workers. Results During the 6-week period following the exponential phase of the pandemic 136 procedures were performed. Ninety-nine (73%) patients had pre-operative SARS-CoV-2 swabs. Forty (29%) had a pre-operative CT Thorax. No patient was found to have SARS-CoV-2 infection pre-operatively. Five (3.6%) of patients developed symptoms that required a second SARS-CoV-2 swab in the post-operative period, all 5 (100%) were negative. No patient developed SARS-CoV-2 infection in the follow-up period, and no member of the urology team developed SARS-CoV-2 infection. Conclusion Our findings demonstrate that elective urological surgery can be safely performed in a region with a low incidence of SARS-CoV-2 with pre-operative screening. We report no cases of symptomatic SARS-CoV-2 infection or deaths among 136 patients undergoing urological surgery.