PMC9035784_01
Time course of the case and clinical findings after SARS-CoV-2 booster vaccination. (A) Time course of booster vaccination, onset of symptoms, admission, oral prednisone, substitution of rFVIIa and FXIII, oral CYC and intravenous RTX treatment. (B) Ecchymosis on the upper and lower extremities and the trunk. CYC, cyclophosphamide; FXIII, factor XIII; IMC, intermediate care unit; rFVIIa, recombinant activated FVII; RTX, rituximab.
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Nine days after mRNA-1273 booster vaccination, the patient started to notice several bruises appearing on his arms, left leg and trunk ( Figure 1A ). The physical exam revealed generalized pallor of the skin and mucous membranes, as well as large ecchymosis on both forearms and elbows, the right trunk and flank as well as the left leg ( Figure 1B ). Figure 1A ). FXIII was substituted three times ( Figure 1A ). In view of the ongoing AHA activity and prolonged need for rFVIIa substitution, the immunosuppression with oral prednisone was continued and the patient received oral cyclophosphamide (CYC, 150 mg daily) from day 18 onwards and weekly treatment with rituximab (RTX, 375 mg/m2) on day 27 ( Figure 1A ).