{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T09:00:59Z","timestamp":1777712459540,"version":"3.51.4"},"reference-count":25,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2024,10,29]],"date-time":"2024-10-29T00:00:00Z","timestamp":1730160000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The International Journal of Lower Extremity Wounds"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:p>Several associations have been made between COVID-19 and vasculitis. Recent data also shows the prevalence and association of de novo vasculitis with either COVID-19 infection or COVID-19 post vaccination. In this article, we present the case of new-onset leukocytoclastic vasculitis, secondary to COVID-19 vaccination, that was complicated by severe infected and nonhealing ulcers in the lower extremities.<\/jats:p>\n                  <jats:sec>\n                    <jats:title>Case<\/jats:title>\n                    <jats:p>A 53-year-old male patient presented to the dermatology clinics with a three-week history of painful necrotic patches coalescent of the lateral malleolus of the right and left ankles. History goes back to when the patient reported developing pruritic papules two weeks after receiving his second shot of the Pfizer BioNTech COVID-19 vaccine (BNT162b2). Punch biopsy was consistent with leukocytoclastic vasculitis. He was prescribed a four-week course of systemic corticosteroids and antibiotics as per cultures. Vascular assessment confirmed normal peripheral arterial and venous system. Two months later, the patient re-presented with fever and worsening of his lower extremity ulcers. He underwent debridement of his wounds. Intra-operative cultures revealed multidrug resistant bacteria. He required an additional debridement session a few days later and a 14-day course of Piperacillin-Tazobactam. The patient was subsequently discharged on corticosteroids and Azathioprine and followed up in the vascular surgery and rheumatology clinics. At four months follow-up, the patient's wounds were almost completely healed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This article highlights a case of severe new-onset COVID-19 vaccine-associated leukocytoclastic vasculitis complicated with infected ulcers that required debridement twice in addition to a prolonged course of antibiotics and immunosuppression therapy. To our knowledge, none of the cases reported in the literature were this severe in nature. In this post-pandemic era, it must remain high on the differential list, and healthcare specialists should maintain a high index of suspicion when evaluating sudden new-onset skin lesions that do not have an immediately apparent etiology.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15347346241275785","type":"journal-article","created":{"date-parts":[[2024,10,29]],"date-time":"2024-10-29T19:46:29Z","timestamp":1730231189000},"page":"723-727","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["COVID-19 and COVID-19 Vaccine-Related Skin Ulcerations in the Lower Extremities: A Case Report and Literature Review"],"prefix":"10.1177","volume":"24","author":[{"given":"Paul","family":"Beaineh","sequence":"first","affiliation":[{"name":"Department of Surgery - Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayman","family":"El-Bsat","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bassel","family":"Hafez","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdul Rahman","family":"Bizri","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut, Beirut, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdul-Ghani","family":"Kibbi","sequence":"additional","affiliation":[{"name":"Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mira","family":"Merashli","sequence":"additional","affiliation":[{"name":"Department of internal medicine, Division of Rheumatology, American University of Beirut Medical Center, Beirut, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2384-2633","authenticated-orcid":false,"given":"Fady","family":"Haddad","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Vascular &amp; Endovascular Surgery, Faculty of Medicine, American University of Beirut, Beirut, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2024,10,29]]},"reference":[{"key":"e_1_3_2_2_2","unstructured":"World Health Organization. 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