Dermatological examination revealed extensive necrosis with surrounding purpura that involved the mons pubis, labia majora, and perineum.
A small but increasing number of thrombotic events have been reported since the launch of mass vaccination campaigns against COVID-19. Adenovirus vector-based vaccines (AstraZeneca and Johnson & Johnson) are associated with severe thrombosis with thrombocytopenia, while mRNA-based vaccines (Pfizer–BioNTech and Moderna) are also associated with some thrombotic events, which do not always accompany thrombocytopenia. The exact pathogenesis remains unknown, but platelet activation is thought to be a key feature underlying these events.
According to authors, to the best of their knowledge, this is the first case of extensive skin necrosis after COVID-19 vaccination that developed outside the injection site.