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.