Sex: M
Vaccine: MMR
Symptoms: Eye pain, Fibrin, Histology, Histology abnormal, Immunisation reaction
Clinical narrative: Leukocytoclastic Vasculitis and Associated Conjunctivitis; Leukocytoclastic Vasculitis and Associated Conjunctivitis; This literature marketed report has been received from the authors of a published article, titled as stated below, and refers to a 78-years-old male patient with a one-year history of lenalidomide (concomitant medication) therapy for multiple myeloma. The patient did not have a history of COVID-19 vaccination.  On an unknown date, the patient was vaccinated with measles, mumps, and rubella (wistar RA 27-3) virus vaccine, live (reported as measles, mumps, and rubella [MMR] vaccine) (manufacturer unknown), formulation was defaulted to subcutaneous injection (dose, dose number, route of administration, anatomical location, lot number and expiration date were not reported) for prophylaxis.  On an unknown date (reported as two weeks after the vaccination), the patient had a rash. On an unknown date, the patient presented to an outpatient dermatology clinic with a two-day history of a painful rash on his hands, as well as red, painful eyes. He denied any recent upper respiratory infection or having started any new medications. At the clinic visit, physical examination was notable for scattered pink dermal papules with a dusky red center bilateral dorsal and palmar hands, as well as bilateral conjunctival erythema. Differential diagnoses included erythema multiforme, acute febrile neutrophilic dermatosis, erythema elevatum diutinum, and multicentric reticulohistiocytosis. On an unknown date, a punch biopsy was taken from the left index finger. On an unknown date, histology on low (hematoxylin-eosin stain; original magnifications: x20) and high (hematoxylin-eosin stain; original magnifications: x200) power showed a moderately dense perivascular and interstitial inflammatory infiltrate composed of lymphocytes, histiocytes, and numerous neutrophils with surrounding papillary dermal edema. High power views demonstrated scattered nuclear dust (karyorrhexis) and fibrin within the walls of the small blood vessels with extravasation of red blood cells in the surrounding stroma (hematoxylin-eosin stain; original magnifications: x400). The patient's histopathological findings were most consistent with leukocytoclastic vasculitis (LCV); the diagnosis was reported as MMR vaccine-related LCV occurring only on the upper extremities with associated conjunctivitis (reported as secondary to immunization with the MMR vaccine) (cutaneous vasculitis, conjunctivitis). It was reported that, in this case, it was unlikely that lenalidomide triggered the patient's vasculitis given that the patient continued to receive lenalidomide without recurrence of the rash. Moreover, the patient had a longstanding prior history of lenalidomide therapy without any occurrence of LCV. On an unknown date (reported as one week later), the patient followed up with a more typical appearing rash for LCV. On an unknown date, the rash was resolved with the use of topical clobetasol ointment and his eyes were also cleared. The patient has continued to receive lenalidomide without any recurrence of the rash. The outcome of the reported events was reported as recovered.  The causality between the events of cutaneous vasculitis, conjunctivitis and measles, mumps, and rubella (wistar RA 27-3) virus vaccine, live (manufacturer unknown) was reported as related.  Upon internal review, the event of cutaneous vasculitis was determined to be medically significant.  A copy of the published article is attached as further documentation of the patient's experience.