Case presentation
The patient was a 41-year-old male who presented to our rheumatology
clinic with atrophic lesions of the neck and left ear and
hyper-pigmented plaques on the left thigh. He claimed that he developed
bullous lesions on his neck, and left thigh about two weeks after
injection of the second dose of COVID-19 vaccination. When he was asked
about the type of the injected vaccines, he reported that the first dose
was Sinopharm BIBP COVID-19 vaccine (BIBP-CorV), and he voluntarily
injected the second dose one month after the first one which was
Oxford/AstraZeneca (ChAdOx1-S [recombinant] vaccine) COVID-19
vaccine. He did not inform the vaccination center about the time and
type of the first injection. His past medical history, drug history, and
familial and social history were unremarkable.
On the meeting day, his vital signs and general examination were within
normal limits except for cutaneous lesions. An atrophic and depigmented
patch was observed on the lateral of the neck. The tip of his left
auricle was atrophic (Figure 1). Purple and pigmented plaques were
detected on the anterior of the left thigh (Figure 2). There were no
signs or symptoms in favor of systemic inflammatory disease. Laboratory
routine tests including cell blood count, renal and liver function tests
and thyroid function tests were all within normal limits.
A biopsy was taken from the thigh lesion which showed vasculitis of the
small vessels with infiltration of inflammatory cells, mainly
neutrophils in the vessel wall, and findings were compatible with
leukocytoclastic vasculitis. Immunological tests were conducted to
investigate possible systemic diseases and revealed negative results for
antinuclear antibody (ANA), anti-double-stranded deoxyribonucleic acid
(anti-ds DNA) antibody, perinuclear and cytoplasmic anti-neutrophil
cytoplasmic antibody (P & C-ANCA), Anti Ro, Anti La,
angiotensin-converting enzyme (ACE), C3, C4, CH50 and anti-cyclic
citrullinated peptide (anti-CCP). Due to the absence of a systemic
disease, the patient was treated with non-steroidal anti-inflammatory
drugs and she was followed up monthly in a rheumatology clinic. There
was no recurrence of the symptoms six months after the vaccine
injection.