COVID‐19 vaccine‐induced urticarial vasculitis

Abstract

Dear Editor, Urticarial vasculitis (UV) is characterized by persistent urticarial rashes that last for more than 24 h and heals with hyperpigmentation. It can be idiopathic or due to drugs, infections, malignancy, autoimmune or autoinflammatory diseases. Rarely, vaccines have been implicated in the causation of UV. A 27-year-old man developed multiple itchy reddish, elevated lesions following one after the second dose of COVID-19 vaccine (whole virion inactivated coronavirus vaccine). It was associated with fever and bilateral knee and ankle joint pain. He received the 1st dose of vaccine 1 month before the 2nd dose. There was no prior history of a similar disease, and the patient denied intake of any other form of medications. Cutaneous examination showed multiple erythematous urticarial plaques over the trunk and extremities (Figure 1A). In most of the lesions, the erythema was non-blanchable in nature, and the plaques were persistent for more than 1 day. Few lesions had healed with post-inflammatory hyperpigmentation. Dermoscopy under polarized mode revealed red dots and globules on a reddish background. Other mucocutaneous, general, and systemic examinations were within normal limits. The biochemical and hematological parameters were normal, except for raised C-reactive protein. Histopathology revealed disruption of the walls of the small vessels, endothelial swelling, erythrocyte extravasation, and mild perivascular infiltration comprising neutrophils, eosinophils, and lymphocytes (Figure 1B,C). Direct immunofluorescence did not reveal any immune deposition. A diagnosis of UV was made, and the patient was treated with oral indomethacin 75 mg once daily, topical calamine lotion, and tab levocetirizine