Case Number : Case 2822- 30 April 2021 Posted By: Dr. Richard Carr

There are 2 foci of sub-epidermal split in image 6, significant dermal eosinophils. Probable cutaneous small vessel vasculitis (about to blister) and could be drug triggered. 
I wonder if the biopsy was taken from a rather old lesion which might have influenced the composition of the dermal cellular infiltrate we see here.

Would be interested to see other thoughts and final suggestion from Dr Carr. 

Lymphocytic vasculitis, with scattered eosinophils, with associated purpuric changes. ?Covid vaccine-related. 

Mix of interface and spongiotic pathology, with lymphocytic vasculitis and eosinophils. Could be a drug rash or vaccine induced. There is a recent report of Pfizer COVID vaccine induced rash, although, no biopsy was done in the case presented. 

Ackerman M, Henry D, Finon A, Binois R, Esteve E. Persistent maculopapular rash after the first dose of Pfizer-BioNTech COVID-19 vaccine. J Eur Acad Dermatol Venereol. 2021 Mar 30. doi: 10.1111/jdv.17248. Epub ahead of print. PMID: 33783017

Agree with the suggestions and descriptions. We suspected this was a vaccine associated rash. Clinically it was quite dramatic and purpuric. It was reported on our UK reporting "yellow" forms for possible drug / vaccine reactions. The patient will require appropriate council on the pros and cons of having the booster vaccine.