We read with interest the article published by Shafie'ei et al.1 regarding a systematic review and meta-analysis of all reported cutaneous side effects of COVID-19 vaccines. Our experience with COVID-19 cutaneous reactions is largely consistent with prior reports of mild, self-limiting cutaneous reactions.2-4 We note reports describing cutaneous vasculitis following COVID-19 vaccination.5 In contrast to the reported mild cutaneous reactions following COVID-19 vaccination, we report the case of a severe prolonged IgA vasculitis following the single dose Janssen COVID-19 vaccine—Ad.26.COV2.S. A 60-year-old Caucasian woman self-presented to the emergency department due to an extensive painful rash affecting her bilateral lower limbs. She described a petechial rash affecting her lower limbs 8 h post the single dose COVID-19 vaccine 11 days prior. Within 10 days, she had developed extensive palpable purpura circumferentially at both lower limbs from the knee distally as well as affecting her thighs and lower abdomen and was referred to dermatology by the emergency physicians (Figure 1A). This was on a background of psoriasis, psoriatic arthritis and hypertension. Her longstanding medications included naproxen, amlodipine, and fexofenadine, and she denied any symptoms of infection. She was apyrexial, and her systems review and examination were unremarkable. Blood tests taken revealed a mildly elevated c-reactive protein of 14 mg/L (normal: <7 mg/L) and erythrocyte sedimentation rate of 26 mm within the first hour (normal: <13 mm) and a normal white blood cell count of 6.41 × 109/L (normal: 3.5–10.5 × 109/L). A chest x-ray and midstream urine showed no evidence of infection. At this time, super-potent topical steroids were prescribed. A punch biopsy taken from her right lower limb demonstrated findings consistent with a leukocytoclastic vasculitis (Figure 2). Direct immunofluorescence demonstrated IgA deposits within vasculature. On follow-up review, tense bullae were seen at her bilateral ankles. Treatment prescribed at this time consisted of tapering oral steroids, oral antibiotics for secondary infection and wound care. The bullae ruptured to leave multiple punched-out and exquisitely painful ulcers (Figure 1B). It was noted that her urinary protein creatinine (UPCR) ratio was uptrending and rose to a value in excess of 100 mg/mmol (normal 0–15 mg/mmol). Complete resolution of the aforementioned lower limb ulceration was noted following 5 months of oral steroid treatment (Figure 1C). Imaging, colonoscopy, and mammography were negative for malignancy. IgA vasculitis represents a small vessel vasculitis brought about by the activation of neutrophils and deposition of IgA at perivascular sites.6 We note a prior case report of postvaccination IgA vasculitis resolving 4 weeks after onset.5 In our case, the complete resolution of the vasculitis and secondary ulceration were noted following 5 months of treatment with oral corticosteroids, which represents the longest reported case. Additionally, our patient had secondary renal involvement with preserved renal function. Her regular medications of naproxen and amlodipine were commenced 5 years prior to this presentation and so were deemed unlikely to be causative. Malignancy and infection were out-ruled. While this presentation may have been coincidental, the relationship between immune complex vasculitis and vaccination has been reported5 and represents the most likely pathophysiological explanation in our patient's case. We feel this case is worth highlighting as it demonstrates a prolonged and severe cutaneous reaction to COVID-19 vaccination. All authors contributed to the editing and execution of this piece. None. The authors report no conflict of interest. The data that support the findings of this study are openly available in Pubmed at https://pubmed.ncbi.nlm.nih.gov/. The patient reported in this article has provided written consent for clinical images to be used in publication.