Exosome Therapy for Livedoid Vasculitis Following COVID-19 Vaccination: A Case Report

Tsung-Kun Lin,1,2,* Chih-Feng Chang,3,* Gwo-Ping Jong4,5 1Department of Pharmacy, Tri-Service General Hospital, Taipei, Taiwan, Republic of China; 2School of Pharmacy, National Defense Medical University, Taipei, Taiwan, Republic of China; 3Division of Cardiology, Department of Internal Medicine, Taichung Armed Force General Hospital, Taichung, Taiwan, Republic of China; 4Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China; 5School of Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China*These authors contributed equally to this workCorrespondence: Gwo-Ping Jong, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China, Email cgp8009@yahoo.com.twAbstract: Livedoid vasculitis is a vascular autoimmune disorder affecting the skin. It most commonly occurs in young women. The occurrence of this condition after the coronavirus 2019 (COVID-19) vaccination is rare. The available literature suggests limited use of exosomes in the treatment of livedoid vasculitis. We present the case of a 65-year-old Chinese man who developed livedoid vasculitis after COVID-19 vaccination. We posit that the etiology in this case may be either COVID-19 vaccine-induced immune stimulation or activation of the condition by a rare vaccine component. This case is unique, with no previously reported precedents. The patient was treated intravenously for 1 month with stem cell-derived exosome therapy, using stem cells derived from exfoliated human deciduous teeth. This resulted in improvement in the livedoid vasculitis, with no reemergence of symptoms. This case highlights the therapeutic benefits of exosome treatment for livedoid vasculitis after COVID-19 vaccination. However, large-scale studies are needed before this outcome can be generalized.Keywords: livedoid vasculitis, COVID-19 vaccination, exosomes, elderly, exfoliated human deciduous teeth