Leukocytoclastic vasculitis (LCV) is an inflammatory entity of small blood vessels due to deposits of immune-complex associated with autoimmune disorder, drug reaction, infection, malignancy, and lymphoproliferative diseases; but up to the half of cases can be idiopathic.1-15. The diagnosis may be confirmed by perivascular lymphocytic infiltrate, red cell extravasation, fragmentation of neutrophils, in addition to fibrinoid necrosis in the small dermal vessels.1-15 The differential diagnosis of small vessel vasculitis includes: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, Amyloidosis, Antiphospholipid syndrome, Atrial myxoma, Behçet disease, Churg-Strauss syndrome, Cogan's syndrome, Microscopic polyangiitis, Granulomatosis with polyangiitis, Henoch-Schönlein purpura, Urticarial vasculitis, Immune thrombocytopenic purpura, Meningococcemia, Paraneoplastic vasculitis, and infection-associated vasculitis (hepatitis B, hepatitis C, and syphilis).1 The clinical manifestations of LCV often disappear after the withdrawal of the causal factor, but the treatment usually includes corticosteroids and other immunosuppressive agents; colchicine or dapsone are used in mild cases, and mycophenolate mofetil or azathioprine in the severe.1,2 More recently, we have the opportunity to read a growing number of case studies describing occurrences of LCV associated with SARS-Cov-2 infection and COVID-19 vaccination.1-6,7-15 Except for COVAXIN, the LCV associated with vaccination involved the mRNA mechanism.3 The SARS-CoV-2 spike protein of vaccines stimulate the cytokines and antibodies production, deposit of immune complexes in small dermal vessels, and fibrinoid necrosis of LCV.1-6,7-15
