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Leukocytoclastic vasculitis after exposure to COVID-19 vaccine

Nov. 24, 2021

She reported daily use of propranolol, metformin and levothyroxine. She described
stability of the polycythemia vera since December 2015. She was submitted to two lower-limb
skin punch biopsies for histopathological analysis and immunofluorescence (IF). Prednisone (1
mg/kg/day) was started once a day. The histopathological examination showed a mixed
inflammatory infiltrate with predominantly perivascular fragmented neutrophils associated with
extravasated red blood cells (Fig. 3 a–c). IF showed deposits of IgA and IgM on the walls of
postcapillary vessels (Fig. 3d). The histological picture was compatible with leukocytoclastic
vasculitis. The patient denied symptoms or a previous clinical picture of COVID-19. The
possibility of cryoglobulinemia was suggested, and serum cryoglobulins were measured, which
were negative. She had elevated C-reactive protein levels and leukocytosis with a leftward shift.
The remaining blood count results, liver function, coagulogram, and partial urine tests were
within the normal limits or compatible with the comorbidities (Table 1). After three days of
hospitalization, she showed improvement of the lower limb lesions and painful symptoms. After
a seven-day treatment with 60 mg prednisone, a progressive reduction was started, and she was
discharged from the hospital on 40 mg/day of prednisone. 

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