SECONDARY URTICARIAL VASCULITIS AND CHRONIC SPONTANEOUS URTICARIA ASSOCIATED WITH COVID-19 VACCINATION

INTRODUCTION: COVID-19 vaccines are generally safe, however there are associated adverse reactions including delayed cutaneous manifestations. This is a case of secondary urticarial vasculitis and chronic spontaneous urticaria associated with COVID-19 vaccination. CASE DESCRIPTION: A 29-year-old male with allergic rhinitis and dermatographism presented with recurrent urticaria. He received his first dose of COVID-19 vaccine and started to have pruritic urticaria on his abdomen after 5 days. Punch biopsy of the lesion showed dermal hypersensitivity response and findings consistent with secondary urticarial vasculitis. His rash improved with topical steroids and oral antihistamines. After the second vaccine, he immediately developed similar symptoms on his face and body. Rheumatologic and infectious work up were unremarkable, and the concern for systemic vasculitis was low. Secondary urticarial vasculitis and hypersensitivity response related to the vaccine was high on the differential given the temporal association. Due to his recurrent pruritic urticaria refractory to high dose of oral antihistamines, omalizumab was started with significant improvement. He is now doing well off omalizumab and on as needed antihistamines only. DISCUSSION: There are reports of delayed cutaneous reactions associated with COVID-19 vaccines. Although rare, it is important to recognize these manifestations of urticarial vasculitis and chronic spontaneous urticaria associated with COVID-19 vaccination.