SHM Converge Scientific Abstract ePoster Gallery-Necrotic Lower Extremity Ulcerations Appearing After Moderna Covid-19 Vaccination

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A 57-year-old woman developed progressive, necrotic lower-extremity ulcers shortly after receiving her second Moderna COVID-19 vaccine dose. Two weeks after vaccination, she began developing bilateral leg ulcers with black eschars. Her medical history included heart failure with reduced ejection fraction, COPD, and a right renal mass.<br /><br />On exam, she was afebrile and not tachycardic. Labs showed mild inflammation, with leukocytosis, elevated ESR, and CRP. A broad evaluation for causes of leg ulcers was performed, including arterial, venous, thrombotic, infectious, neuropathic, and inflammatory etiologies. Thrombophilia testing and rheumatologic workup were largely negative. CT angiography of the chest, abdomen, pelvis, and legs showed no evidence of vasculitis.<br /><br />Biopsy of the ulcers revealed fibrin thrombi and neutrophilic inflammation, consistent with thrombotic vasculopathy and leukocytoclastic vasculitis. A wound culture grew pan-sensitive Pseudomonas aeruginosa, but ciprofloxacin did not lead to improvement.<br /><br />Because of the close timing between vaccination and lesion onset, the clinicians believed the most likely diagnosis was thrombotic vasculopathy possibly associated with the Moderna vaccine. The patient was treated with rivaroxaban and later experienced improvement and healing.<br /><br />The report notes that while mRNA COVID-19 vaccines are known to be associated with some thrombotic events and various skin rashes, ulcerating cutaneous reactions have not been previously reported by the authors. They suggest this may be the first reported case of necrotic lower-extremity ulcers due to thrombotic vasculopathy after an mRNA COVID-19 vaccine, though more cases are needed to confirm a causal link.

Asset Subtitle

Jay Li

Meta Tag

Author List Jay Li, Stephen Chiang

Category Clinical Vignettes

Concept Lower-extremity Ulcer

Concept Thrombotic Vasculopathy

Concept Thrombosis

Concept Fibrin Thrombus

Concept Antiplatelet Therapy

Distinguished Non-Finalist

Presenter Organization University of Michigan Medical School

Presenting Author Jay Li

Track Adult

Keywords

Moderna COVID-19 vaccine

thrombotic vasculopathy

necrotic leg ulcers

lower-extremity ulcers

leukocytoclastic vasculitis

fibrin thrombi

rivaroxaban

cutaneous adverse reaction

mRNA vaccine

Pseudomonas aeruginosa

Lower-extremity Ulcer

Thrombotic Vasculopathy

Thrombosis

Fibrin Thrombus

Antiplatelet Therapy