First documented case of urticarial vasculitis following the AstraZeneca COVID-19 vaccine
British Journal of Dermatology
; 186(6):e254, 2022.
Article
in English
| EMBASE | ID: covidwho-1956702
ABSTRACT
The COVID-19 pandemic resulted in a rapid requirement for a safe and effective vaccination programme. Currently, three types of vaccines exist mRNA (Pfizer), adenoviral vector (AstraZeneca) and inactivated whole-virus vaccines (Sinofarm). These all have reported cutaneous side-effects, including papulovesicular, pityriasis rosea-like and papulosquamous eruptions (McMahon DE, Kovarik CL, Damsky W et al. Clinical and pathologic correlation of cutaneous COVID-19 vaccine reactions including V-REPP a registry-based study. J Am Acad Dermatol 2021;86 113-21). We present a case of delayed type III hypersensitivity reaction clinically resembling urticarial vasculitis (UV) in a 66-year-old woman following AstraZeneca vaccine. She initially reported urticarial lesions on the hands after the first vaccination;these settled spontaneously. On subsequent vaccination she developed a florid rash 4 days later, presenting to Accident & Emergency with angio-oedema, malaise and urticaria. The eruption was presumed viral given the mildly elevated C-reactive protein, and negative lateral flow test for COVID-19. She was given fexofenadine 180 mg QDS for 6 weeks;however, the rash persisted and became more widespread over the following 4 weeks. The initial urticated wheals persisted >24 h, becoming bruise-like and painful. Skin biopsy confirmed UV. ANA, complement, ANCA and COVID-19 polymerase chain reaction were nonsignificant. We believe this is the first documented case of UV triggered by the AstraZeneca vaccine and the third case of UV following a Sars-CoV-2 vaccine reported in English literature. The two other cases were secondary to Pfizer and whole-virus vaccine, respectively. From the literature it is believed UV is potentially caused by the coronavirus particles rather than vaccine additives, as the Sars-CoV-2 nucleocapsid has been demonstrated in skin lesions of asymptomatic COVID-19 patients with UV (Criado PR, Criado RFJ, Gianotti R et al. Urticarial vasculitis revealing immunolabelled nucleocapsid protein of SARS-CoV-2 in two Brazilian asymptomatic patients the tip of the COVID-19 hidden iceberg? J Eur Acad Dermatol Venereol 2021;35 e563-6). Thus, although rare, clinicians should be aware of this entity.
C reactive protein; endogenous compound; fexofenadine; neutrophil cytoplasmic antibody; nucleocapsid protein; vaxzevria; accident; adverse drug reaction; aged; angioneurotic edema; asymptomatic coronavirus disease 2019; case report; clinical article; conference abstract; contusion; coronavirus disease 2019; female; gene amplification; human; iceberg; lateral flow immunochromatography; malaise; nonhuman; polymerase chain reaction; rash; Severe acute respiratory syndrome coronavirus 2; side effect; skin biopsy; skin defect; type III hypersensitivity; urticaria; vaccination; vasculitis; virus nucleocapsid
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Topics:
Vaccines
Language:
English
Journal:
British Journal of Dermatology
Year:
2022
Document Type:
Article
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