¹Gianina Statache ¹Iman Hussein Hobbeldin

¹ADSCC

Introduction: Raynaud’s phenomenon (RP) is a condition that causes the blood vessels in the extremities to narrow with restriction of the blood flow. RP usually affects the fingers and toes but rarely might occur in the ears or nose. Secondary RP occur usually due to the presence of underlying rheumatological autoimmune disorder, and to a lesser extent due to coagulation disorders.

While Coronavirus disease-19 (COVID-19) originated in Wuhan-China, within a few months it was declared a global pandemic by the World Health Organization (WHO), and a number of vaccines received emergency approval in an attempt to compact the COVID-19 that is highly contagious. RP in association with COVID-19 vaccination is generally rare. Few cases were reported. No previous report came from the Middle East region.

Method(s): We report a case of a new-onset RP, which occurred in an otherwise healthy young Arabic ethnicity woman, who lacked any known risk factors and associations with possible causes for secondary RP.

Result(s): A young; 32-year-old, Arabic Ethnicity woman (Ms. KA), Called the Rheumatology clinic of Al-Kuwait-Dubai Hospital (Al Baraha Hospital) complaining of transient attacks of well-demarcated, whitening fingers, of both hands which were triggered by exposure to cold environment and accompanied by a sensation of numbness. Ms. KA sent a photo to explain her complaints. The photo revealed well-demarcated white fingers on the right 2nd, 3rd, and fourth finger, and on the left 3rd, 4th, and 5th finger (Figure 1). Ms. KA had been given an urgent appointment the next day at the clinic. On presentation to the clinic, she gave a history of receiving her second injection of the inactivated SARS-CoV-2 vaccine, BBIBP-CorV one week prior to the development of the RP. Ms. KA is otherwise healthy with no other comorbidities or autoimmune diseases, she has no known allergy, is not married, and not using oral contraception or any other medications. She is not a current or ex-smoker. And could not recall any vibratory triggers. She works as an HR personnel with no previous history and no family history of RP.

On examination, there were well-demarcated, white-pale, cold areas involving the volar and dorsal aspects of the right 2nd, and 3rd finger, and the left 2nd, 4th, and 5th finger (Figure. 2). The remaining digits showed no abnormalities There was no digital pitting, ulceration, or gangrene. The peripheral pulses of both arms were symmetrical and of normal character.

Investigations revealed: normal complete blood count and biochemistry, coagulation parameters including cryoglobulins. Antibodies profile was all negative for ANA, Anti-dsDNA, Anti SS-A/RO, Anti SS-B/La, Anti-JO1, Anti smith antibody (AntiSM), Anti-RNP, Anti-centromere antibody, Anti-scleroderma 70, Anti -Histone, Anti-cardiolipin antibody, Rheumatoid Factor (RF), and anti-CCP. Normal complements and cryoglobulins range. Antibodies to the heparin/platelet factor 4 complex are not detectable. coagulation profile was normal including antibodies to the heparin/platelet factor 4 (PF4) Complex.

The absence of current or previous immunological or coagulation disease, the absence of RP in her past medical history, the lack of any RP risk factors and triggers, complete normal related blood tests, and the recent administration of the COVID-19 vaccine collectively raise doubt about RP relation to the inactivated CVOID-19 vaccine.

Conclusion(s): Although COVID-19 vaccination was necessary to control the COVID-19 pandemic. The temporal association between the RP and the requires long-term observation and pharmacovigilance to monitor all the related adverse events of the vaccines.