COVID-19-associated vasculitis and thrombotic complications: from pathological findings to multidisciplinary discussion

Vacchi, Caterina; Meschiari, Marianna; Milić, Jovana; Tonelli, Roberto; Alfano, Gaetano; Volpi, Sara; Faltoni, Matteo; Franceschi, Giacomo; Ciusa, Giacomo; Bacca, Erica; Tutone, Marco; Alessandro, Raimondi; Menozzi, Marianna; Franceschini, Erica; Cuomo, Gianluca; Orlando, Gabriella; Santoro, Antonella; Gaetano, Margherita Di; Puzzolante, Cinzia; Carli, Federica; Bedini, A.; Cossarizza, Andrea; Castaniere, Ivana; Ligabue, Guido; Ruvo, N. De; Manco, Gianrocco; Rolando, Giovanni; Gelmini, Roberta; Maiorana, Antonino; Girardis, Massimo; Mascia, Maria Teresa; Mussini, Cristina; Salvarani, Carlo; Guaraldi, Giovanni

doi:10.1093/rheumatology/keaa581

Cited by 21 publications

(22 citation statements)

References 14 publications

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“…Weston et al report a 12 year old girl with likely previous asymptomatic infection with SARS-CoV-2 who developed biopsy proven vasculitis associated with myeloperoxidase antibodies and needing aggressive management through corticosteroids, Rituximab and Cyclophosphamide [ 123 ]. A case of bowel perforation secondary to gut vasculitis has been reported [ 124 ] and another who eventually died following bowel inflammation and perforation [ 125 ]. Another case with medium vessel vasculitis was not given any treatment and resolved spontaneously highlighting the challenges around management of these patients [ 126 ].…”

Section: Resultsmentioning

confidence: 99%

Rheumatological complications of Covid 19

Zacharias

Dubey

Koduri

et al. 2021

Autoimmunity Reviews

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Introduction COVID-19 has caused unprecedented hardships in the 21st century with more than 150 million infections. Various immunological phenomena have been described during the course of the infection, and this infection has also triggered autoimmunity. Rheumatological illnesses have been described following resolution of the acute infection; hence we sought to conduct a review of the rheumatological complications of COVID-19. Methods We conducted a literature search for articles relating to sequelae of COVID-19 from Jan 2020 to 30th April 2021. Results We found a number of reports of inflammatory arthritis after SARS-CoV-2 infection. SLE and renal disease have been described, and vasculitis also appears to be a common complication. Rhabdomyolysis and myositis has also been reported in a number of patients. We also found some evidence of large vessel vasculitis in ‘long COVID’ patients. Conclusions This review highlights a number of important complications such as inflammatory arthritis, lupus-like disease, myostis and vasculitis following SARS-CoV-2 infection.

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Section: Resultsmentioning

confidence: 99%

Rheumatological complications of Covid 19

Zacharias

Dubey

Koduri

et al. 2021

Autoimmunity Reviews

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“…Cases of COVID-19-related vasculitis are reported in the literature and this could be a possible reason for our patient developing vasculitis in an otherwise stable RA disease pattern. 14 We will briefly review the recently studied mechanisms of COVID-19 that may play a role in propelling vasculitis.…”

Section: Discussionmentioning

confidence: 99%

Does withdrawal of immunosuppression in rheumatoid arthritis after SARS-CoV-2 infection increase the risk of vasculitis?

et al. 2021

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We describe a case of a 48-year-old woman who presented with acute respiratory failure due to diffuse alveolar haemorrhage and acute renal failure due to pauci-immune glomerulonephritis consistent with a new diagnosis of microscopic polyangiitis (MPA). The patient had a recent SARS-CoV-2 infection 6 weeks before MPA diagnosis and had stopped immunosuppression for her rheumatoid arthritis (RA) at that time. The patient was treated with pulse intravenous steroids, plasma exchange therapy and rituximab, which induced remission of her illness. This case highlights a timely dilemma of holding immunosuppression in a RA patient with low disease activity on combination therapy with SARS-CoV-2 infection, and the potential risk of developing an additional autoimmune disease, such as vasculitis, given their existing autoimmunity due to RA.

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“…A 73-year-man presented with arterial vasculitis at splenic hilum resulting in splenic infarction concomitantly with COVID-19 infection. The condition improved after splenectomy (71). Another 71year-old man developed abdominal and bilateral common iliac arteritis concurrent with COVID-19 infection, with subsequent spontaneous remission (70).…”

Section: Systemic Vasculitismentioning

confidence: 98%

“…Concurrent ileocecal vasculitic ulcers was found in a 40-year-old female COVID-19 patient, who then only received supportive treatment (72). Notably, virus particles have been found in the cytoplasm of vascular endothelial cells in the biopsy specimen of one patient (72), whereas SARS-CoV-2 RT-PCR was negative in another patient's biopsy (71). A 37-year-old woman suffered from anti-proteinase 3 (PR3)-positive diffuse alveolar hemorrhage concurrent with SARS-CoV-2 infection and later received treatments of intravenous methylprednisolone pulse therapy, plasmapheresis, and IVIG.…”

Section: Systemic Vasculitismentioning

confidence: 99%

Autoimmune and Rheumatic Manifestations Associated With COVID-19 in Adults: An Updated Systematic Review

2021

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Background: Numerous cases of the coronavirus disease 2019 (COVID-19) with autoimmune and rheumatic manifestations have been reported. Despite the available reviews that summarized its autoimmune/rheumatic manifestations, a systematic approach is still lacking. Therefore, we conducted a comprehensive systematic review in order to give an overview upon these rare but clinically significant manifestations.Methods: We performed a literature search of PubMed and EMBASE as of October 9, 2020. All articles relevant to either systemic or organ-specific autoimmune and rheumatic manifestations potentially associated with COVID-19 were collected. The reviewed literature were limited to adults ≥18 years.Results: Although most of the existing evidence was based on case reports or case series without a long-term follow-up, a variety of autoimmune/rheumatic manifestations were associated with COVID-19. The manifestations that have a consistent association with COVID-19 include autoimmune cytopenia, cutaneous vasculitis, encephalitis, and Guillain-Barre syndrome. Such association is conflicting as regards to antiphospholipid syndrome, hemophagocytic lymphohistiocytosis, and myasthenia gravis.Conclusion: Our systematic review indicated the potential of the COVID-19 virus to trigger a myriad of autoimmune and rheumatic manifestations, which should be considered amid global efforts to combat COVID-19.

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COVID-19-associated vasculitis and thrombotic complications: from pathological findings to multidisciplinary discussion

Cited by 21 publications

References 14 publications

Rheumatological complications of Covid 19

Rheumatological complications of Covid 19

Does withdrawal of immunosuppression in rheumatoid arthritis after SARS-CoV-2 infection increase the risk of vasculitis?

Autoimmune and Rheumatic Manifestations Associated With COVID-19 in Adults: An Updated Systematic Review

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