Vasculitis refers to the inflammation and damage of blood vessel walls. This presents as erythematous macules or palpable purpura with a predilection for dependent parts, particularly the legs. Vesicles and bullae are less common manifestations. Vasculitis can be idiopathic or associated with infections, systemic diseases, drugs, or vaccines. Vaccine-associated vasculitis has been reported in BCG, influenza, hepatitis, and more recently, COVID-19 vaccines. However, there is limited data on the adverse events associated with rabies vaccine administration.

A 53-year-old Filipino male presented with petechiae evolving into purpura and urticarial targetoid plaques with bullae on the extremities and trunk, after administration of inactivated purified Vero cell rabies vaccine (Verorab, Sanofi Pasteur) due to a Category 3 bite. There were no mucosal lesions. Nikolsky and Asboe-Hansen signs were negative. The patient had no previous reactions to drugs or vaccines.

Histopathology results confirmed the diagnosis of vasculitis. Resolution of skin lesions was achieved with administration of intravenous steroids and oral antihistamines.

Community surveys conducted in three Philippine provinces report the incidence of animal bites at 50 injuries per 1,000 population (5 percent) per year with 45 percent of patients seeking medical treatment at animal bite treatment centers.

There is limited data on adverse events associated with rabies vaccine administration. In general, allergic reactions to vaccines are rare, occurring in approximately 1 in 50,000 to 1 in 1,000,000 doses. These reactions may be due to antigens, residual media, stabilizers, preservatives, or other excipients in the vaccine.

Rash, urticaria, and pruritus have been reported, along with injection site reactions such as erythema, edema, and pain. Fever, malaise, headaches, low mood, purpura, urticaria, Stevens-Johnson Syndrome and erythema multiforme may also occur.

Adequate documentation and reporting of adverse reactions due to vaccines contributes to long-term safety studies and establishing treatment guidelines.