Urticarial vasculitis after <scp>COVID</scp> ‐19 vaccination: A case report and literature review
Urticarial vasculitis after <scp>COVID</scp> ‐19 vaccination: A case report and literature review
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<scp>COVID</scp> -19疫苗接种后荨麻疹性血管炎：病例报告及文献复习
DOI：
10.1111/dth.15613
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发表时间：
2022
影响因子：
3.6
通讯作者：
Shimizu Akira
中科院分区：
文献类型：
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作者：
Ono Hiroto;Yamaguchi Reimon;Shimizu Akira
自身免疫性疾病荨麻疹性血管炎（UV）可能由药物、恶性肿瘤、其他自身免疫性疾病和感染引起。1最近，它与COVID-19疫苗接种有关。2-5一名68岁的男子在第三剂辉瑞-BioNTech COVID-19疫苗接种后4天出现多处发红、隆起、瘙痒的病变，并向当地医生就诊。他报告对前两次给药无反应。由于使用15 mg泼尼松龙（PSL）治疗没有改善，他被转诊到我们的诊所。他的病史包括心绞痛、糖尿病、血脂异常，近期未改变药物。他的体温是37.8 ℃。体格检查显示躯干、四肢和大腿散在水肿性红斑伴色素沉着和紫癜（图1A、B）。口腔粘膜正常。虽然他报告喉咙不适，但没有明显的喉水肿或上呼吸道症状。实验室检查结果包括C反应蛋白（10.04 mg/dl）、白细胞（9400个细胞/mm 3）、中性粒细胞分数（89.2%）和血小板、嗜酸性粒细胞、C3、C4和ANA升高，均在正常范围内。COVID-19定量抗原检测呈阴性。组织学检查显示血管周围和间质细胞浸润。（图1C）。高倍镜示真皮层嗜中性粒细胞浸润。观察到伴有核尘和红细胞渗漏的白细胞破碎性血管炎（图1D）。未进行直接免疫荧光。患者被诊断为UV。由于最初怀疑感染引起出血性荨麻疹，PSL逐渐减少，并添加富马酸卢帕他定和静脉注射头孢唑林。胸部和腹部CT扫描显示无感染灶。两天后，发热消退，4天后，即接种后8天，他的皮疹几乎消失，大腿内侧留下色素沉着。他出院了，没有复发。至少有3份病例报告2-4和1篇综述文章5，包括COVID-19疫苗接种后的紫外线发病率。关于病例报告; Dash报告了一名27岁的男性，他在第二次接种灭活的全病毒体冠状病毒后1天出现皮疹，接受了吲哚美辛、外用炉甘石洗剂和左西替利嗪治疗; Nazzaro报告了一名27岁的女性，她在第一次接种Moderna后10天出现皮疹
The autoimmune disorder urticarial vasculitis (UV) may be caused by drugs, malignancy, other autoimmune diseases, and infections. 1 And it has recently been associated with COVID-19 vaccination. 2–5 A 68-year-old man presented to a local doctor with multiple, reddish, elevated, itchy-lesions that appeared 4 days after his third dose of Pfizer-BioNTech COVID-19 vaccine. He reported no reactions to the first two doses. Since treatment with 15 mg prednisolone (PSL) yielded no improvement, he was referred to our clinic. His medical history included angina pectoris, diabetes mellitus, dyslipidemia, and no recent drug changes. His body temperature was 37.8 C. Physical examination revealed edematous erythema with pigmentation and purpura scattered on his trunk, extremities, and thighs (Figure 1A, B). Oral mucosa was normal. Although he reported discomfort in the throat, no laryngeal edema or upper respiratory tract symptoms were evident. Laboratory results included elevated C-reactive protein (10.04 mg/dl), leukocytes (9400 cells/mm3), neutrophil fraction (89.2%), and platelet, eosinophil granulocyte, C3, C4, and ANA all within normal range. Quantitative antigen test for COVID-19 was negative. Histopathological examination showed perivascular and interstitial cell infiltration.(Figure 1C). High-power view showed infiltration of neutrophils throughout the dermis. Leukocytoclastic vasculitis with nuclear dust and erythrocyte leakage was observed (Figure 1D). Direct immunofluorescence was not performed. The patient was diagnosed with UV. Since infection induced hemorrhagic urticaria was initially suspected, PSL was tapered and rupatadine fumarate and intravenous cefazolin were added. Chest and abdominal CT scans revealed no focus of infection. Two days later, the fever resolved and by 4 days later, which was 8 days post-vaccination, his skin rash had almost disappeared leaving pigmentation on the inner thighs. He was discharged from hospital and has had no recurrence. There have been at least three case reports 2–4 and 1 review article 5 including incidences of UV following COVID-19 vaccination. Regarding the case reports; Dash reported a 27-year-old man who developed skin rash 1 day after his second dose of inactivated whole virion coronavirus whom was treated with indomethacin, topical calamine lotion and levocetirizine; Nazzaro reported a 27-year-old woman who developed skin rash 10 days after her first dose of Moderna