A case of COVID-19 vaccination-associated forme fruste purpura fulminans.

We report the case of a female, 77 year old patient with multi-localized skin infarctions following vaccination with mRNA-1273 (Moderna). This phenomenon is to our knowledge otherwise only seen in infection-associated purpura fulminans - which was thoroughly ruled out in our patient. This report demonstrates that we need to be vigilant of a wider array of vascular phenomena related to Covid vaccinations.

dear editor, A 77‐year‐old female patient developed multiple painful lesions 2 weeks after her first COVID‐19 vaccination with mRNA‐1273 (Moderna, Cambridge, MA, USA). (a) The figure shows the clinical presentation 4 weeks after the first COVID‐19 vaccination (arrows indicate the distribution of lesions on the back). (b) Histopathology showed full‐thickness necrosis of the dermis with thrombotic occlusion of virtually all capillaries and arterioles without concomitant inflammation suspicious of a septic embolic process. Coagulation occurred without pathology; no relevant medication history was reported. (c) Two weeks later (6 weeks after vaccination), lesions were sharply demarcated (without treatment). Time kinetics, distribution of lesions and exclusion of other known causes suggest that the purpura fulminans‐like lesions were vaccination‐associated. However, clinicians should not be diverted from careful investigation of other causes if they encounter similar events.

Author Contribution

Johannes Griss: Conceptualization (equal); Investigation (equal); Project administration (lead); Visualization (equal); Writing‐original draft (lead); Writing‐review & editing (equal). Sabine Eichinger: Conceptualization (equal); Investigation (equal); Writing‐review & editing (equal). Winkler Stefan: Investigation (equal); Writing‐review & editing (equal). Wolfgang Weninger: Investigation (equal); Writing‐review & editing (equal). Peter Petzelbauer: Conceptualization (equal); Investigation (equal); Project administration (equal); Supervision (equal); Writing‐review & editing (equal).