“Mechanic’s Hand” with Polyarthralgia and Transient Autoimmune Features after COVID Vaccination

Abstract

Autoimmune diseases are now well reported with COVID vaccination. Rheumatological, neurological, cardiac, and hematological adverse events are observed globally. Dermatological adverse events are reported in a few cases but dermatological with rheumatological manifestation with reversible autoimmune phenomenon after COVID vaccination is not reported commonly in literature. “Mechanic’s hands” is blackish discoloration of palmar aspects of both hands and knuckles commonly reported in rheumatological autoimmune condition such as dermatomyositis. In this case report, a 28-year-old male presented with polyarthralgia with myalgia and fatigability after 1 month of COVID vaccination. His joint pain symptoms worsened over 4 weeks and developed blackish pigmentation of both hands predominantly involving palms to present as mechanic’s hands. Vasculitis workup was inconclusive and rheumatologic workup documented raised antinuclear antibody titers and rheumatoid factor. We have started him on steroid and hydroxychloroquine and observed satisfactory clinical response with near complete resolution of “mechanic’s hands” in 24 weeks. Mechanic’s hands with rheumatological syndrome which is a rare vaccine-related adverse event, reversible, and easily treatable with routinely available medicines, and importantly it is having excellent prognosis. Mechanic’s hand is first time reported in medical literature after COVID vaccination. Minimal systemic adverse events are known to occur with all viral vector vaccines, but its occurrence is rare and it should not impact on routine vaccinations, as vaccination is a key step in this pandemic to protect humankind.

Keywords

• antinuclear antibody test
• covid vaccine
• mechanic’s hand
• rheumatological syndrome