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Published in: BMC Infectious Diseases 1/2021

Open Access 01-12-2021 | Vasculitis | Case report

First description of immune complex vasculitis after COVID-19 vaccination with BNT162b2: a case report

Authors: Victoria Therese Mücke, Viola Knop, Marcus Maximilian Mücke, Falk Ochsendorf, Stefan Zeuzem

Published in: BMC Infectious Diseases | Issue 1/2021

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Abstract

Background

Cases of immune complex vasculitis have been reported following COVID-19 infections; so far none in association with novel mRNA-based COVID-19 vaccination. This case report describes a cutaneous immune complex vasculitis after vaccination with BNT162b2.

Case presentation

A 76-year old male with liver cirrhosis developed an immune complex vasculitis 12 days after the second injection of BNT162b2. On physical examination, the patient presented with pruritic purpuric macules on hands and feet, flexor and extensor parts of both legs and thighs and lower abdomen, and bloody diarrhoea. Laboratory testing showed elevated inflammatory markers. After short treatment with oral steroids all clinical manifestations and laboratory findings resolved.

Conclusions

An increasing number of clinical manifestations have been attributed to COVID-19 infection and vaccination. This is the first written report of immune complex vasculitis after vaccination with BNT162b2. We present our case report and a discussion in the light of type three hypersensitivity reaction.
Literature
1.
go back to reference Coronaviridae Study Group of the International Committee on Taxonomy of V. The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol. 2020;5(4):536–44.CrossRef Coronaviridae Study Group of the International Committee on Taxonomy of V. The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol. 2020;5(4):536–44.CrossRef
3.
go back to reference Yadav T, Srivastava N, Mishra G, et al. Recombinant vaccines for COVID-19. Hum Vaccin Immunother. 2020;16(12):2905–12.CrossRef Yadav T, Srivastava N, Mishra G, et al. Recombinant vaccines for COVID-19. Hum Vaccin Immunother. 2020;16(12):2905–12.CrossRef
4.
go back to reference Lamb YN. BNT162b2 mRNA COVID-19 vaccine first approval. Drugs. 2021;81(4):495–501.CrossRef Lamb YN. BNT162b2 mRNA COVID-19 vaccine first approval. Drugs. 2021;81(4):495–501.CrossRef
7.
go back to reference Iba T, Connors JM, Levy JH. The coagulopathy, endotheliopathy, and vasculitis of COVID-19. Inflamm Res. 2020;69(12):1181–9.CrossRef Iba T, Connors JM, Levy JH. The coagulopathy, endotheliopathy, and vasculitis of COVID-19. Inflamm Res. 2020;69(12):1181–9.CrossRef
8.
go back to reference Galvan Casas C, Catala A, Carretero Hernandez G, et al. Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases. Br J Dermatol. 2020;183(1):71–7.CrossRef Galvan Casas C, Catala A, Carretero Hernandez G, et al. Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases. Br J Dermatol. 2020;183(1):71–7.CrossRef
9.
go back to reference Gautret P, Million M, Jarrot PA, et al. Natural history of COVID-19 and therapeutic options. Expert Rev Clin Immunol. 2020;16(12):1159–84.CrossRef Gautret P, Million M, Jarrot PA, et al. Natural history of COVID-19 and therapeutic options. Expert Rev Clin Immunol. 2020;16(12):1159–84.CrossRef
10.
go back to reference Mohamadian M, Chiti H, Shoghli A, Biglari S, Parsamanesh N, Esmaeilzadeh A. COVID-19: virology, biology and novel laboratory diagnosis. J Gene Med. 2021;23(2):e3303.CrossRef Mohamadian M, Chiti H, Shoghli A, Biglari S, Parsamanesh N, Esmaeilzadeh A. COVID-19: virology, biology and novel laboratory diagnosis. J Gene Med. 2021;23(2):e3303.CrossRef
11.
go back to reference Manzo G. COVID-19 as an immune complex hypersensitivity in antigen excess conditions: theoretical pathogenetic process and suggestions for potential therapeutic interventions. Front Immunol. 2020;11:566000.CrossRef Manzo G. COVID-19 as an immune complex hypersensitivity in antigen excess conditions: theoretical pathogenetic process and suggestions for potential therapeutic interventions. Front Immunol. 2020;11:566000.CrossRef
12.
go back to reference al-Sheyyab M, Batieha A, el-Shanti H, Daoud A. Henoch-Schonlein purpura and streptococcal infection: a prospective case-control study. Ann Trop Paediatr. 1999;19(3):253–5.CrossRef al-Sheyyab M, Batieha A, el-Shanti H, Daoud A. Henoch-Schonlein purpura and streptococcal infection: a prospective case-control study. Ann Trop Paediatr. 1999;19(3):253–5.CrossRef
13.
go back to reference Roncati L, Ligabue G, Fabbiani L, et al. Type 3 hypersensitivity in COVID-19 vasculitis. Clin Immunol. 2020;217:108487.CrossRef Roncati L, Ligabue G, Fabbiani L, et al. Type 3 hypersensitivity in COVID-19 vasculitis. Clin Immunol. 2020;217:108487.CrossRef
14.
go back to reference Chen SX, Cohen PR. Cutaneous leukocytoclastic vasculitis following influenza vaccination in older adults: report of bullous purpura in an octogenarian after influenza vaccine administration. Cureus. 2018;10(3):e2323.PubMedPubMedCentral Chen SX, Cohen PR. Cutaneous leukocytoclastic vasculitis following influenza vaccination in older adults: report of bullous purpura in an octogenarian after influenza vaccine administration. Cureus. 2018;10(3):e2323.PubMedPubMedCentral
15.
go back to reference Wolf ME, Luz B, Niehaus L, Bhogal P, Bazner H, Henkes H. Thrombocytopenia and intracranial venous sinus thrombosis after “COVID-19 vaccine AstraZeneca” exposure. J Clin Med 2021;10(8). Wolf ME, Luz B, Niehaus L, Bhogal P, Bazner H, Henkes H. Thrombocytopenia and intracranial venous sinus thrombosis after “COVID-19 vaccine AstraZeneca” exposure. J Clin Med 2021;10(8).
16.
go back to reference Team CC-R, Food DA. Allergic reactions including anaphylaxis after receipt of the first dose of Pfizer-BioNTech COVID-19 vaccine-United States, December 14–23, 2020. MMWR Morb Mortal Wkly Rep. 2021;70(2):46–51.CrossRef Team CC-R, Food DA. Allergic reactions including anaphylaxis after receipt of the first dose of Pfizer-BioNTech COVID-19 vaccine-United States, December 14–23, 2020. MMWR Morb Mortal Wkly Rep. 2021;70(2):46–51.CrossRef
17.
go back to reference Bomback AS, Kudose S, D’Agati VD. De novo and relapsing glomerular diseases after COVID-19 vaccination: what do we know so far? Am J Kidney Dis 2021. Bomback AS, Kudose S, D’Agati VD. De novo and relapsing glomerular diseases after COVID-19 vaccination: what do we know so far? Am J Kidney Dis 2021.
18.
go back to reference Polack FP, Thomas SJ, Kitchin N, et al. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. N Engl J Med. 2020;383(27):2603–15.CrossRef Polack FP, Thomas SJ, Kitchin N, et al. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. N Engl J Med. 2020;383(27):2603–15.CrossRef
19.
go back to reference Grigorescu I, Dumitrascu DL. Spontaneous and antiviral-induced cutaneous lesions in chronic hepatitis B virus infection. World J Gastroenterol. 2014;20(42):15860–6.CrossRef Grigorescu I, Dumitrascu DL. Spontaneous and antiviral-induced cutaneous lesions in chronic hepatitis B virus infection. World J Gastroenterol. 2014;20(42):15860–6.CrossRef
20.
go back to reference Ko HM, Hernandez-Prera JC, Zhu H, et al. Morphologic features of extrahepatic manifestations of hepatitis C virus infection. Clin Dev Immunol. 2012;2012:740138.CrossRef Ko HM, Hernandez-Prera JC, Zhu H, et al. Morphologic features of extrahepatic manifestations of hepatitis C virus infection. Clin Dev Immunol. 2012;2012:740138.CrossRef
21.
go back to reference Gupta N, Kim J, Njei B. Spontaneous bacterial peritonitis and Henoch-Schonlein purpura in a patient with liver cirrhosis. Case Rep Med. 2015;2015:340894.CrossRef Gupta N, Kim J, Njei B. Spontaneous bacterial peritonitis and Henoch-Schonlein purpura in a patient with liver cirrhosis. Case Rep Med. 2015;2015:340894.CrossRef
22.
go back to reference Radic M, Martinovic Kaliterna D, Radic J. Drug-induced vasculitis: a clinical and pathological review. Neth J Med. 2012;70(1):12–7.PubMed Radic M, Martinovic Kaliterna D, Radic J. Drug-induced vasculitis: a clinical and pathological review. Neth J Med. 2012;70(1):12–7.PubMed
23.
go back to reference Goeser MR, Laniosz V, Wetter DA. A practical approach to the diagnosis, evaluation, and management of cutaneous small-vessel vasculitis. Am J Clin Dermatol. 2014;15(4):299–306.CrossRef Goeser MR, Laniosz V, Wetter DA. A practical approach to the diagnosis, evaluation, and management of cutaneous small-vessel vasculitis. Am J Clin Dermatol. 2014;15(4):299–306.CrossRef
Metadata
Title
First description of immune complex vasculitis after COVID-19 vaccination with BNT162b2: a case report
Authors
Victoria Therese Mücke
Viola Knop
Marcus Maximilian Mücke
Falk Ochsendorf
Stefan Zeuzem
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2021
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-021-06655-x

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