A Case of Leukocytoclastic Vasculitis Following SARS-COV-2 Vaccination

Although vaccination against coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been proven generally safe, rare but potentially serious adverse reactions do occur. Leukocytoclastic vasculitis (LCV) is a small-vessel vasculitis that has been associated with other immunizations, but, to our knowledge, has not been previously reported in association with vaccines directed against SARS-CoV-2.

We report the case of a 22-year-old man with no known past medical history who presented to the Emergency Department with 2 days of migratory arthritis in his ankles and palpable purpura on his bilateral lower extremities, occurring 10 days after receiving the Johnson & Johnson SARS-CoV-2 vaccine. The patient's clinical presentation was suggestive of leukocytoclastic vasculitis, and this diagnosis was confirmed on skin biopsy. Why Should an Emergency Physician Be Aware of This? Recognition of vasculitides is important for timely treatment and prevention of complications. In a patient presenting with palpable purpura after immunization against SARS-CoV-2, LCV should be promptly considered and worked up by the Emergency Physician, though management is most often entirely outpatient and the clinical course is typically mild and self-resolving.