A Transient Increase in the Serum ANCAs in Patients with SARS-CoV-2 Infection: A Signal of Subclinical Vasculitis or an Epiphenomenon with No Clinical Manifestations? A Pilot Study

Abstract

A relationship is emerging between SARS-CoV-2 infections and ANCA-associated vasculitis (AAV) because: (i) the pulmonary involvement of COVID-19 may mimic that observed in patients with AAV; (ii) the two diseases may occur together; (iii) COVID-19 may trigger AAV. However, few cases of AAV have been identified so far in COVID-19 patients. To define the frequency of ANCA autoimmunity in patients with SARS-CoV-2 infection, we analyzed the serum ANCAs and the serum PR3 and MPO antigens by immunoassays in 124 adult patients with a diagnosis of SARS-CoV-2 infection (16 were asymptomatic and 108 were hospitalized) and 48 control subjects. The serum ANCAs were significantly higher in the hospitalized patients compared with either the controls or the asymptomatic patients and increased with the progression of the COVID-19 severity. After one week of hospitalization, the values were significantly lower. In contrast, no differences emerged among the controls, asymptomatic and hospitalized patients for the PR3 and MPO serum levels. None of the patients had clinical signs of AAV with the exception of a severe pulmonary involvement. Further studies are necessary to define whether the increase in the serum ANCAs might mask subclinical vasculitis in a percentage of patients with SARS-CoV-2 infection or it is an epiphenomenon of SARS-CoV-2 infection with no clinical manifestations.

New Onset of Autoimmune Diseases Following COVID-19 Diagnosis

“…The presence of ANCA was detected in patients with SARS-CoV-2 infection without overt AAV and its presence is considered an epiphenomenon due to hyperstimulation of the immune system by the infection [ 143 , 144 , 145 ]. Considering ANCA are pathogenic in AAV, whether ANCA+ COVID-19 patients may develop overt AAV during follow-up is an unanswered question.…”

ANCA-associated vasculitis following ChAdOx1 nCoV19 vaccination: case-based review

“…Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection induces an exaggerated immune response in susceptible individuals [ 1 , 2 ]. The development of autoantibodies in a tiny minority is consequential to the release of Proteinase-3 (PR-3), Myeloperoxidase (MPO) and other antigens by the neutrophils in response to SARS-CoV-2 infection.…”

A Case Report of MPO-ANCA-Associated Vasculitis Following Heterologous mRNA1273 COVID-19 Booster Vaccination

“… 2 Although further studies should be continued, it was identified that myeloperoxidase (MPO) titer has been increased after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in a pilot study. 3 Despite that the immune responses after natural infection with SARS-CoV-2 and mRNA vaccination could differ, there have been concerns about antineutrophil cytoplasmic antibody (ANCA) vasculitis after COVID-19 vaccines. 4 …”