Diffuse cutaneous systemic sclerosis following SARS-Co V-2 vaccination

The largest world-wide vaccination rollout ever is currently underway to tackle the covid-19 pandemic. We report a case of diffuse cutaneous systemic sclerosis (SSc) in a 70-year-old male with rapidly progressive skin thickening which developed two weeks after receiving the first dose of the ChAdOx1 nCOV-19 vaccine. As the onset of SSc skin was in close temporal proximity to the administration of the first dose vaccine with no other triggers, we suspected a possible adverse reaction to the ChAdOx1 nCOV-19 vaccine. We hypothesise that the recombinant adenoviral vector encoding the spike protein antigen of SARS-CoV-2 triggered an unexpected immune activation resulting in an atypical presentation of late-onset SSc, within the well-recognised ANA positive, ENA negative subgroup of patients.We review the possible mechanisms underlying autoimmunity when provoked by vaccination and other published rheumatological phenomenon occurring shortly after COVID vaccination. •A case of diffuse systemic sclerosis after vaccination with ChAdOx1 vaccine.•Mechanisms of autoimmunity include ‘bystander effect’ and molecular mimicry.•There may be a pathological role for endosomal TLR9-driven activated B cells.•Review of rheumatological phenomenon observed following COVID vaccination.