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1.
Annals of the Rheumatic Diseases ; 81:1731, 2022.
Article in English | EMBASE | ID: covidwho-2008936

ABSTRACT

Background: Primary Sjögren's syndrome (pSS) is a chronic and progressive multisystem autoimmune disease which rarely onset in children and adolescents. Diagnostic delay in large part of patients are common due to the non-specifc and variable symptoms and the slow progression of disease. Objectives: To analyse demographic data, specifc extraglandular, salivary and ocular manifestations, laboratory parameters and therapy of pSS with juvenile onset. Methods: Retrospective study of all patients (pts) with pSS in single center. Results: pSS was verifed in 15 pts (6.7% were boys), which amounted to 23.8% of all pts with SS in our pediatric rheumatologic department. The median age of pSS onset was 8.0 y.o. [IQR 7.0;10.2]. The median of disease duration at the time of pSS verifcation was 2.75 years [2.2;5.6]. All patients had systemic manifestations at onset: constitutional abnormalities-33.3%, nonerosive polyarthritis-64.3%, polyarthralgias-26.7%, lymphadenopathy-73.3%, cutaneous involvement-53.3% (2-xerosis, 2-annular erythema, 1-erythema nodo-sum, 2-Raynaud phenomenon, 2-nonspecifc spotty rashes, 1-hemorrhagic rash). At the time of diagnosis 7 pts (46.7%) had isolated involvement of salivary glands, 8 pts (53.3%)-combined with involvement of lacrimal glands. The decrease in salivary gland function was recorded in 80% of cases, hypolacrimia-in 46.7%, 1 patient had isolated hypolacrimia. Recurrent parotitis was present in 6 pts (40.0%). At time of diagnosis pulmonary involvement had 20.0% of pts, 1 patient had renal tubular acidosis. 8 pts (53.3%) had various hematological disorders: anemia-in 3 pts (20.0%), leukopenia-in 6 (40.0%). ANA Hep-2 were detected in 100% pts (in titer 1/640-4, 1/1280-7, 1/2560-3, 1/20480-1, with mixed patterns in all pts: speckled + homogeneous-9 pts, speckled + homogeneous+cytoplasmic-6 pts), anti-Ro-in 12 pts (80.0%), anti-La-in 8 pts (53.3%), RF+-in 9 pts (60.0%). 6 pts (40.0%) had polyclonal hypergammaglob-ulinemia, max 42%. 2 pts (13.3%) had concomitant autoimmune non-rheumatic disease;1-cutaneous psoriasis, 1-autoimmune thyroiditis. The treatment of each patient was justifed by the main individual manifestations: 93.3% received glucocorticoids, 26.7%-methotrexate, 33.3%-hydroxychloroquine, 6.7%-mycophenolate mofetil. Treatment with biologics (B) was received by 13 (93.3%) pts (7-rituximab (RTM), 6-abatacept (ABA)) with a good response in 10 pts, including improvement in the function of the salivary and lacrimal glands in 7 pts. 1 patient received 2B-RTM and ABA sequentially due to the development of MAS 7 days after 1st RTM infusion. B was discontinued in 3 pts: 1 due to development of hemorrhagic vasculitis 2 days after the 1st RTM infusion, 1-COVID-19 with lung involvement (CT 3-4) 2 weeks after the 1st RTM infusion, 1-inefficiency of ABA during 15 months. Conclusion: In our pediatric rheumatologic department pts with pSS made up less than a quarter of all pts with SS. The diagnosis was verifed delayed in all pts, which can be explained by a wide range of nonspecifc manifestations at the onset. However, the manifestations of SS that were present at the time of diagnosis were brought under control on the background of complex therapy, including the prescription of B, with a good efficacy and safety profile of therapy.

2.
British Journal of Dermatology ; 186(6):e248, 2022.
Article in English | EMBASE | ID: covidwho-1956704

ABSTRACT

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).

3.
British Journal of Dermatology ; 186(6):e253, 2022.
Article in English | EMBASE | ID: covidwho-1956703

ABSTRACT

We present the case of a severe cutaneous reaction following COVID-19 vaccination. A 60-year-old white woman presented to our service with an extensive painful, pruritic rash affecting her bilateral lower limbs. This was on a background of psoriasis, psoriatic arthritis and notably inoculation against COVID-19 with the Johnson & Johnson vaccine hours prior to onset. There was no history of new medications, illicit drug use or infections. On examination, extensive palpable purpura was noted circumferentially at both lower limbs from the knee distally. Tense bullae were described at her bilateral ankles. She was apyrexial. Her cardiopulmonary and gastrointestinal examinations were normal. A punch biopsy taken from her right lower limb demonstrated findings consistent with leucocytoclastic vasculitis (LCV). Direct immunofluorescence demonstrated IgA deposits within the vasculature. IgA LCV secondary to COVID-19 vaccination was proposed on the basis of histological and clinical findings. Treatment consisted of oral steroids, oral antibiotics for secondary infection and wound dressings. Opioid analgesia and nitrous oxide were implemented for severe pain associated with dressing changes. As her urinary protein creatinine ratio was in excess of 100 mg dL-1 and microscopic haematuria was noted on urine microscopy, she was referred to nephrology. We note case reports of patients diagnosed with LCV up to 2 weeks following COVID-19 vaccination (Cavalli G, Colafrancesco, De Luca G et al. Cutaneous vasculitis following COVID- 19 vaccination. Lancet Rheumatol 2021;3: E743-4). In this case, onset of symptoms occurred within hours. While this presentation may have been coincidental, the relationship between immune complex vasculitis, COVID-19 infection (Iraji F, Galehdari H, Siadat AH, Bokaei Jazi S. Cutaneous leukocytoclastic vasculitis secondary to COVID-19 infection: a case report. Clin Case Rep 2020;9: 830-4) and vaccination (Cavalli et al.) has been reported in the literature and represents the most likely diagnosis.

4.
Acta Clinica Belgica: International Journal of Clinical and Laboratory Medicine ; 77(sup1):1-33, 2022.
Article in English | EMBASE | ID: covidwho-1886341
6.
Journal of the Egyptian Women's Dermatologic Society ; 19(2):108-114, 2022.
Article in English | EMBASE | ID: covidwho-1884552

ABSTRACT

Background Coronavirus disease 2019 (COVID-19)-infected individuals can be asymptomatic or have mild symptoms. Cutaneous affection with COVID-19 is a unique presentation. Objective To describe the clinical presentations of skin affection in COVID-19-confirmed patients attending a dermatology outpatient clinic. Patients and methods A retrospective analysis was performed on the medical records of a single dermatology outpatient clinic described cutaneous presentations associated with COVID-19 infection in patients attending in the period from October 2020 to December 2020. Results A total of 44 COVID-19-positive patients presented with skin affection. The most common presentation was urticaria (24, 54.5%), followed by herpes simplex (seven, 15.9%), herpes zoster (four, 9.1%), papulosquamous (three, 6.9%), papulovesicular (two, 4.6%), acral lesions (two, 4.6%), leukocytoclastic vasculitis (one, 2.3%), and Kawasaki-like disease (one, 2.3%). Nine (20.5%) patients had asymptomatic COVID-19 infection, 24 (54.5%) patients had mild COVID-19, nine (20.5%) patients had moderate COVID-19, and two (4.5%) patients had severe COVID-19. Among patients with COVID-19 symptoms (35, 79.5%), seven (20%) patients presented with the cutaneous presentation before the onset of COVID-19 symptoms, whereas in the rest of the patients, cutaneous affection was simultaneous with COVID-19 symptoms (28, 80%). Conclusion Cutaneous affection can be the striking presentation for COVID-19 requiring dermatological consultation. Awareness and early recognition of skin affection associated with COVID-19 are required. Dermatologists should follow all of the precautions and use adequate personal protective equipment during their outpatient practices. Skin presentations, notably urticaria, can precede the systemic and respiratory symptoms of COVID-19. Severe mucocutaneous herpes simplex can occur with COVID-19 and require prompt medical treatment.

7.
Journal of the American College of Cardiology ; 79(9):3245, 2022.
Article in English | EMBASE | ID: covidwho-1768654

ABSTRACT

Background: Vasculitis is a known, although not commonly observed, manifestation of bacterial endocarditis. It is imperative that diagnosis is made promptly and appropriately treated, as vasculitis can often be painful and uncomfortable for patients. Case: 75-year-old male is admitted to the hospital for Coronavirus Disease 2019 (COVID-19). Several weeks after recovering from his respiratory infection, patient developed a diffuse, purpuric rash that began on his forearms and gradually spread throughout his bilateral upper extremities to his hands and fingers, as well as to his shoulders and lateral chest. Skin biopsy was performed and revealed findings suggestive of leukocytoclastic vasculitis. Blood work revealed Methicillin Resistant Staph Aureus (MRSA) bacteremia, sensitive to Vancomycin. Transthoracic echocardiogram revealed native mitral valve endocarditis. Transesophageal echocardiogram was not performed due to patient's underlying comorbidities and high risk. Decision-making: Patient was diagnosed with leukocytoclastic vasculitis secondary to bacterial endocarditis. Rheumatologic workup, including antineutrophil cytoplasmic antibodies, antinuclear antibodies, serum complement levels, anti-smith antibodies and double stranded deoxyribonucleic acid, was negative. Patient was ultimately discharged on a prolonged course of Vancomycin and his diffuse rash resolved one month later. Conclusion: There are only a few case reports describing the direct association between leukocytoclastic vasculitis and infective endocarditis. It is important to consider the association of vasculitis and endocarditis in order to effectively treat because immunosuppression, particularly with steroids, is the gold standard treatment for vasculitis. Our patient experienced near complete resolution of the rash after completion of antibiotics and no other therapy was deemed necessary.

8.
J Cosmet Dermatol ; 21(5): 1822-1829, 2022 May.
Article in English | MEDLINE | ID: covidwho-1723294

ABSTRACT

COVID-19 is a systemic disease characterized by vascular damage, increased inflammation, and hypercoagulability. Acral ischemic lesions occur as a result of increased inflammation and cutaneous thrombosis. Skin lesions can sometimes be the only symptom of COVID-19. In this respect, recognizing acro-ischemic lesions, which are skin lesions, may help in the early diagnosis of the disease and in predicting the prognosis. In patients with skin lesions without typical symptoms, the diagnosis of COVID-19 should be kept in mind. Herein, we describe five patients affected by COVID-19 which developed acro-ischemic lesions.


Subject(s)
COVID-19 , Skin Diseases , COVID-19/complications , Humans , Inflammation/pathology , Ischemia/diagnosis , Ischemia/etiology , Skin/pathology , Skin Diseases/pathology
9.
Clin Case Rep ; 10(2): e05390, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1669383

ABSTRACT

In 2020, the SARS-COV-2 disease (COVID-19) imposed huge challenges on the health, economic, and political systems, and by the end of the year, hope had been born with the release of COVID-19 vaccines aimed at bringing the pandemic to an end. However, the COVID-19 vaccination programs have sparked several concerns and ongoing debates over safety issues. Here, we presented three cases of patients with serious adverse events, encephalopathy, vaccine-induced thrombotic thrombocytopenia, and leukocytoclastic vasculitis, after receiving the ChAdOx1 nCoV-19 vaccine. Therefore, it is critical to investigate and report the occurrence of adverse reactions following vaccination, particularly serious ones, as it contributes to the growing body of research and assists clinicians in better diagnosing and managing them.

10.
Nephrol Ther ; 18(4): 287-290, 2022 Jul.
Article in French | MEDLINE | ID: covidwho-1649775

ABSTRACT

SARS-CoV-2 vaccines are being administered worldwide. Most side effects are mild and self-limiting with few reported cases of severe reactions. We report a case of leukocytoclastic vasculitis with acute kidney failure following aninactivated SARS-CoV-2 vaccine, unique for its dramatic visual presentation and its rapid response to treatment. This is the case of a 58years-old man presenting with fever, arthralgias and vascular purpura on his limbs associated with acute kidney failure requiring hemodialysis nine days after anti-COVID-19 vaccination. Skin biopsy revealed a leukocytoclastic vasculitis and a renal biopsy showed an acute tubulointerstitial nephritis. The vascular purpura resolved 7days after initiating treatment with prednisone but the patient remains in chronic renal failure. The analysis and investigation of the complications and adverse events induced by anti-COVID-19 vaccines could increase our understanding of the underlying pathogenesis.


Subject(s)
Acute Kidney Injury , COVID-19 Vaccines , COVID-19 , Acute Kidney Injury/etiology , COVID-19/complications , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Humans , IgA Vasculitis , Male , SARS-CoV-2 , Vasculitis, Leukocytoclastic, Cutaneous
11.
JAAD Case Rep ; 18: 1-3, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1630331
13.
Ann Med Surg (Lond) ; 74: 103249, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1620469

ABSTRACT

Vasculitis is one of the complications of COVID-19. We conducted a systematic review analysing the association of COVID-19 with vasculitis. We searched Google Scholar and PubMed from December 1, 2019, to October 11, 2021. The review included 8 studies (7 case reports and 1 case series) reporting 9 cases of vasculitis secondary to COVID-19. The mean age was 29.17 ± 28.2 years, ranging from 6 months to 83 years. The male to female ratio was 4:5. Maculopapular, violaceous, papular and erythematous rash were common. Heparin(n = 2), corticosteroids (n = 6) (methylprednisolone) and intravenous immunoglobulin (n = 4) were prescribed in these patients. Significant clinical improvement was observed in 8 out of 9 patients. One person died during treatment. Our study discusses vasculitis as one of the complications of COVID-19. Furthermore, the pathophysiology, clinical presentation, and management of COVID-19 associated vasculitis is discussed.

14.
Dermatol Ther ; 35(3): e15279, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1583588

ABSTRACT

Leukocytoclastic vasculitis (LCV) is the vasculitis of small vessels. In this report, we describe a 38-year-old male patient who presented to our outpatient clinic with a 1-week history of rash on his lower extremities that had started 4 days after receiving the Pfizer-BioNTech SARS-CoV-2 vaccine. A diagnosis of LCV was made based on clinical and histopathological findings. The patient was treated with antihistamines and prednisolone, after which improvement was observed in the lesions. With this paper, we aim to raise awareness concerning the possibility of LCV development after COVID-19 vaccination.


Subject(s)
/adverse effects , COVID-19 , Vaccination , Vasculitis, Leukocytoclastic, Cutaneous , Adult , COVID-19/prevention & control , Histamine Antagonists/therapeutic use , Humans , Male , Prednisolone/therapeutic use , SARS-CoV-2 , Vaccination/adverse effects , Vasculitis, Leukocytoclastic, Cutaneous/chemically induced , Vasculitis, Leukocytoclastic, Cutaneous/diagnosis , Vasculitis, Leukocytoclastic, Cutaneous/drug therapy
15.
J Autoimmun ; 127: 102783, 2022 02.
Article in English | MEDLINE | ID: covidwho-1587360

ABSTRACT

Vaccinations may induce cutaneous adverse events, due to nonspecific inflammation or immuno-mediated reactions. Several types of vasculitis have been observed. We report on a 71-year-old woman who developed cutaneous small-vessel vasculitis after the second dose of Vaxzevria COVID-19 vaccination, showing leukocytoclastic vasculitis on histopathological examination of a skin biopsy. Cutaneous small-vessel vasculitis is a rare condition which can be idiopathic or secondary to underlying infections, connective tissue disorders, malignancy, and medications. The pathogenesis involves immune complex deposition in small blood vessels, leading to activation of the complement system and recruitment of leukocytes. Exacerbation of small-vessel vasculitis has been reported following the administration of various vaccines, particularly influenza vaccine. It is expected that SARS-CoV-2 vaccine results in the activation of B- and T-cells and antibody formation. We hypothesize that leukocytoclastic vasculitis caused by immune complex deposition within cutaneous small vessels could be a rare side effect of Vaxzevria COVID-19 vaccination.


Subject(s)
COVID-19 Vaccines/adverse effects , Vasculitis, Leukocytoclastic, Cutaneous/etiology , Aged , Female , Humans , Neutrophil Infiltration , Prednisone/therapeutic use , Vasculitis, Leukocytoclastic, Cutaneous/blood , Vasculitis, Leukocytoclastic, Cutaneous/drug therapy , Vasculitis, Leukocytoclastic, Cutaneous/pathology
16.
British Journal of Surgery ; 108(SUPPL 6):vi83, 2021.
Article in English | EMBASE | ID: covidwho-1569598

ABSTRACT

Leukocytoclastic vasculitis (LV) is an inflammation of the small vessels in the dermis characterised by the deposition of immunocomplexes in the involved vessel walls. It commonly manifests as palpable purpura, limited to the skin and predominantly of the lower limb. We report a rare case of necrotising LV (NLV) affecting bilateral breast, manifesting clinical features of necrotising fasciitis (NF), and emphasizes the potential diagnostic challenges that markedly influence the treatment and survival of patients. A 48-year-old female presented with an acute onset left breast skin necrosis and discolouration that rapidly progressed to the contralateral breast with surrounding erythema and oedema of the chest wall yet spared the intermammary cleft. Some non-blanching purpuric rash were also noted on upper abdomen and left lower limb. COVID-19 test was negative. CT scan showed extensive bilateral breast fat stranding and oedema. Patient became clinically septic with a moderately raised CRP and mild acute kidney injury. Radical mastectomies and chest wall excision were performed with intra-operative findings of cloudy fluid and easily peeled away subcutaneous tissue from fascia. Urgent gram stain and culture showed no organisms. Tissue biopsies subsequently showed the diagnosis of NLV. Chest wall defect was then reconstructed with split skin grafts, NLV treated with corticosteroids and patient made an uneventful recovery. This case highlights the incidence of a rare and aggressive manifestation of NLV on the breast that mimics NF, emphasizing the clinical differentiation that may lead to catastrophic results and significant cosmetic defect, if a differential diagnosis cannot be determined at the time.

17.
Italian Journal of Medicine ; 15(3):39, 2021.
Article in English | EMBASE | ID: covidwho-1567516

ABSTRACT

Case report: A 67-year-old male presented to our hospital with a sudden eruption of pruritic, erythematous-to-violaceous purpura and plaques distributed along the lower and upper extremities and low back. Ten days prior he was vaccinated with Vaxzevria. No systemic involvement or manifestation was perceived. He had no prior history of allergy or purpuric skin eruption and had not recently started any new medication. Laboratory tests (included autoimmunity screening) and instrumental examinations were normal, except for a mild pericardial effusion. Biopsies obtained from the left arm both showed a picture compatible with leucocytoclastic vasculitis. After discussing risks and benefits the patient was discharged with topical steroids and a prednisone taper. Discussion: Vasculitis exacerbation has been reported secondary to multiple vaccines. However, this relationship is rare and it has yet to be determined. A possible mechanism might be vessel damage likely secondary to abnormal immunological activation with vaccine-related antigens promoting antibody development and immune complex deposition. Despite systemic steroids cause variable effects on immunity, up to 20 mg/day of prednisone seems to not have any effect on patients' immune response to vaccines. For the CoViD-19 vaccine, it is speculated that regardless of the type of vaccine, systemic corticosteroids have no or minimal risk in patients' immune response. Conclusions: It is important for healthcare providers to be aware that the CoViD-19 vaccine can potentially precipitate or exacerbate cutaneous inflammation.

18.
J Cutan Pathol ; 49(4): 385-387, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1518011

ABSTRACT

Leukocytoclastic vasculitis has been reported in the setting of COVID-19 infection and post-COVID-19 vaccination. We report a case of IgA vasculitis (IgAV) post-COVID-19 vaccination, with immunoglobulin A (IgA) immune deposits in the skin and renal involvement. SARS-CoV spike protein immunohistochemical staining was negative. IgAV with skin and renal involvement is a potential reaction to COVID-19 vaccination.


Subject(s)
COVID-19 Vaccines/adverse effects , /etiology , Aged, 80 and over , Drug-Related Side Effects and Adverse Reactions/complications , Drug-Related Side Effects and Adverse Reactions/etiology , Drug-Related Side Effects and Adverse Reactions/physiopathology , Humans , Immunohistochemistry/methods , Male
19.
J Emerg Med ; 2021 Oct 23.
Article in English | MEDLINE | ID: covidwho-1474722

ABSTRACT

BACKGROUND: 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. CASE REPORT: 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.

20.
Dermatol Ther ; 34(6): e15141, 2021 11.
Article in English | MEDLINE | ID: covidwho-1429610

ABSTRACT

With the present COVID-19 vaccination drive across the world, adverse skin reactions post COVID-19 vaccine is expected. Majority of these reactions seen were transient or local injection site reactions. However, as the larger population is being vaccinated, certain uncommon dermatological presentations including leukocytoclastic vasculitis, pityriasis rosea, and exacerbation of pre-existing autoimmune diseases are now being reported. Among all the COVID-19 vaccines, most of these reactions are seen with messenger ribonucleic acid-based Pfizer/BioNTech (BNT162b2) and Moderna (mRNA-1273) vaccine. We report two cases of leukocytoclastic vasculitis following ChAdOx1 nCoV-19 corona virus vaccine (recombinant) that bring out potential new dermatological manifestations of recombinant corona virus vaccine being administered across the European, South American, and Asian countries. It is important for all health care workers and patients to be aware of the corona virus vaccine associated adverse cutaneous reactions.


Subject(s)
COVID-19 , Skin Diseases , COVID-19 Vaccines , Humans , SARS-CoV-2 , Vasculitis, Leukocytoclastic, Cutaneous
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