Recurrent Mixed Cryoglobulinemic Vasculitis Following Influenza Vaccination

Mixed cryoglobulinemic vasculitis is a small-vessel vasculitis most commonly caused by hepatitis infection, autoimmune diseases, and lymphoproliferative disorders. Vaccine-induced cases are exceedingly rare. We present an 83-year-old man with no known risk factors who presented on 2 separate occasions with bilateral lower-extremity purpuric rash and acute kidney injury. Cryoprecipitate immunofixation and skin biopsy confirmed type II cryoglobulinemic vasculitis. Notably, influenza vaccination had been administered 1 week before both episodes. The recurrence following vaccination on 2 occasions, in the absence of alternative causes, suggests a causal relationship and the importance of considering vaccine-induced vasculitis when traditional causes are excluded.