Virus and Autoimmunity: Can SARS-CoV-2 Trigger Large Vessel Vasculitis?

Abstract

Introduction: Viral infections can induce autoimmune diseases in susceptible patients. SARS-CoV-2 has been associated with the development of rheumatic disease, especially small vessel vasculitis and arthritis. Typically, onset occurs days to weeks after the antigenic challenge and in patients with mild COVID-19. We report a case of large vessel vasculitis (LVV) temporally related to SARS-CoV-2 infection. Case description: An otherwise healthy 19-year-old woman presented with fatigue, malaise, and chest and low back pain. The symptoms had begun 5 weeks earlier and 1 month after mild SARS-CoV-2 infection. Serological work-up revealed a marked proinflammatory state and anaemia without signs of infectious or autoimmune disease. Computerized tomography revealed thickening and blurring of the perivascular fat of the descending thoracic and abdominal aorta, progressing along the proximal iliac and renal arteries. Fluorodeoxyglucose positron emission tomography confirmed inflammatory activity. Symptoms and laboratory values normalized after prednisolone treatment. Discussion: Recent SARS-CoV-2 infection may be a trigger for LVV, including Takayasu arteritis, as well as other rheumatic diseases. A prompt and thorough differential diagnosis is essential to exclude aortitis and LVV mimickers. Moreover, physicians should be aware of the potential spectrum of systemic and autoimmune diseases that could be precipitated by SARS-CoV-2 infection. This will allow timely diagnosis and treatment, with significant improvement in prognosis.

Is COVID-19 All That Glitters?

“…Mendes et al described the case report of a 19-year-old woman who presented fatigue and malaise one month after a SARS-CoV-2 infection. Adequate diagnostic workup led to a Takayasu arteritis diagnosis, as shown by the concentric and diffuse thickening of the thoracic and abdominal aorta with a CT scan, similar to our case report [ 18 ]. To date, nevertheless, there is a limited number of literature studies supporting the existence of a causal link; thus, it is not possible to exclude that the association between SARS-CoV-2 and Takayasu arteritis was casual in reported clinical cases.…”

“…According to these data and the increasing evidence suggesting an association between the SARS-CoV-2 infection and autoimmunity [ 17 ], it is possible to hypothesize the presence of a link between SARS-CoV-2 infection and vasculitis. Indeed, during the pandemic, several SARS-CoV-2-associated Takayasu arteritis cases in young patients of a similar age to our clinical case have been described [ 18 , 19 , 20 ]. Mendes et al described the case report of a 19-year-old woman who presented fatigue and malaise one month after a SARS-CoV-2 infection.…”

Takayasu – Arteriitis nach COVID-19-Infektion bei einer 26 Jahre alten Patientin mit Morbus Crohn

“…Es wurden bisher zahlreiche Fallberichte veröffentlicht, welche das Auftreten von verschiedensten Immunvermittelten Krankheiten (u. a. Aortitis) nach COVID-19-Infektion beschreiben [36,37,38,39,40,41]. Die Mehrheit der Patienten wies lediglich milde Symptome der Covid-19-Infektion mit Husten, Schnupfen und Fieber auf.…”

A case of self‐remitting periaortitis in a hemodialysis patient after COVID‐19

“…However, aortitis and periaortitis after COVID-19 on chronic kidney disease (CKD) patient have not ever been reported. Only five cases of aortitis and periaortitis without CKD have been reported [2][3][4]. Therefore, this clinical entity was hitherto unknown.…”

“…The five cases without CKD previously reported were all treated with high-dose prednisolone or nonsteroidal antiinflammatory drugs (NSAIDs). Only one patient was treated with NSAIDs [4]; the others were successfully treated with 40-60 mg prednisolone [2,3]. In the cases with CKD, aggressive treatment with high-dose prednisolone is often a very high-risk option, and NSAIDs sometimes worsen renal function.…”