Raynaud's Phenomenon after COVID-19 Vaccination: Causative Association, Temporal Connection, or Mere Bystander?

Abstract

Herein, we report a case of a new-onset Raynaud's phenomenon (RP), which occurred in an otherwise healthy 31-year-old Caucasian woman, who lacked any known risk factors and associations with possible causes for secondary RP. However, 2 weeks prior to the development of RP, the patient had received her first injection of the COVID-19 vaccine containing ChAdOx1-SARS-COV-2. The patient presented with well-demarcated, white-pale, cold areas involving the middle fingers of both hands and the ring finger of the right hand, which were triggered by exposure to cold environment and accompanied by a sensation of numbness. Infrared thermography revealed notable temperature differences of up to 10.9°C between affected and nonaffected fingers. Coagulation and immunological parameters, including cryoglobulins and pathological autoantibodies, were within the normal range and antibodies to the heparin/platelet factor 4 complex not detectable. It remains unclear if the development of RP in our patient is causally related to antecedent COVID-19 vaccination; however, the temporal connection to the vaccination, the complete absence of RP in her past medical history, and the lack of any risk factors and triggers raise the suspicion of a yet unknown association with the vaccine. Whether a clear association between the development of RP and COVID-19 vaccination exists or whether RP represents a bystander effect needs to be awaited in case observational reports on RP accumulate. Given the steadily rising numbers of people receiving COVID-19 vaccinations, physicians may remain alert to still unrecognized side effects.

Keywords: COVID-19 vaccination; COVID-19 vaccine; Raynaud's phenomenon; Raynaud's syndrome.

Fig. 1

Raynaud's phenomenon. Well-demarcated, white-pale, cold areas affecting the middle finger of the left hand of a 31-year old, otherwise healthy, woman.

Fig. 2

A Nailfold capillaroscopy of the middle finger of the left hand showing normal morphology, density, and dimensions of the capillaries. B Thermogram of both hands, revealing temperature differences of up to 10.9°C between the individual fingers with 21.4°C and 21.2°C in the left index and middle finger, respectively, indicating reduced perfusion, and 32.1°C and 30°C in the right middle and ring finger, indicative of reactive hyperemia.