Post-SARS-CoV-2 vaccine small vessel vasculitis in a 13-year-old girl: A case report

Abstract

Abstract Background Cutaneous small vessel vasculitis (CSVV) or leukocytoclastic vasculitis (LCV) is a subgroup of vasculitis localized to the skin. Regarding the COVID-19 vaccine, it is postulated that some patients develop an inflammatory reaction to vaccine components encoding the SARS-CoV‐2 spike glycoprotein, which targets the endothelium and results in CSVV with endothelial cell inflammation and dysfunction. Although post-COVID-19 vaccination small vessel vasculitis has been reported in the literature and some cases had necrotic reactions after receiving Pfizer and AstraZeneca. Case presentation: We report the first pediatric case of post-Sinopharm COVID-19 vaccine small vessel vasculitis. Five months after receiving the second dose of the mentioned vaccine, a 13-year-old girl developed gangrene-like symptoms, starting as painful, tingling sensations on the left forefinger. Spiral CT angiography of both upper extremities showed vasculitis and narrowing of the left radial and ulnar arteries. Pathology specimen from a punch biopsy of the skin was consistent with acute neutrophilic LCV involving small blood vessels, and the bone marrow aspiration biopsy noted a moderately hypocellular marrow. Our treatment included a single dose of cyclophosphamide, 2 doses of rituximab, 5 episodes of plasmapheresis (QOD), vasodilators, and sympathetic blockade. A good outcome was achieved. Conclusions Post-COVID-19 small vessel vasculitis in pediatric patients is rare but can be diagnosed and treated effectively using histopathological analysis and specific treatments.