Virus and Autoimmunity: Can SARS-CoV-2 Trigger Large Vessel Vasculitis?
  • João Lázaro Mendes
    Internal Medicine Department, Centro Hospitalar Tondela-Viseu, Viseu https://orcid.org/0000-0001-5868-7739
  • Gabriela Venade
    Internal Medicine Department, Centro Hospitalar Tondela-Viseu, Viseu
  • Paula Manuel
    Internal Medicine Department, Centro Hospitalar Tondela-Viseu, Viseu
  • Luís Costa Matos
    Internal Medicine Department, Centro Hospitalar Tondela-Viseu, Viseu; Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã
  • Edite Nascimento
    Internal Medicine Department, Centro Hospitalar Tondela-Viseu, Viseu

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.

VIEW THE ENTIRE ARTICLE

References

  • Smatti MK, Cyprian FS, Nasrallah GK, Al Thani AA, Almishal RO, Yassine HM. Viruses and autoimmunity: a review on the potential interaction and molecular mechanisms. Viruses 2019;11(8):762.
  • Zacharias H, Dubey S, Koduri G, D'Cruz D. Rheumatological complications of Covid 19. Autoimmun Rev 2021;20(9):102883.
  • Gracia-Ramos AE, Martin-Nares E, Hernandez-Molina G. New onset of autoimmune diseases following COVID-19 diagnosis. Cells 2021;10(12):3592.
  • Espinoza JL, Ai S, Matsumura I. New insights on the pathogenesis of Takayasu arteritis: revisiting the microbial theory. Pathogens 2018;7(3):73.
  • Keser G, Aksu K. Diagnosis and differential diagnosis of large-vessel vasculitides. Rheumatol Int 2019;39(2):169–185.
  • Dejaco C, Ramiro S, Duftner C, Besson FL, Bley TA, Blockmans D, et al. EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice. Ann Rheum Dis 2018;77(5):636–643.
  • Águeda AF, Monti S, Luqmani RA, Buttgereit F, Cid M, Dasgupta B, et al. Management of Takayasu arteritis: a systematic literature review informing the 2018 update of the
  • EULAR recommendation for the management of large vessel vasculitis. RMD Open 2019;5(2):e001020.
  • Wong K, Farooq Alam Shah MU, Khurshid M, Ullah I, Tahir MJ, Yousaf Z. COVID-19 associated vasculitis: a systematic review of case reports and case series. Ann Med Surg
  • (Lond) 2022;74:103249.
  • Giryes S, Bragazzi NL, Bridgewood C, De Marco G, McGonagle D. COVID-19 vasculitis and vasculopathy-distinct immunopathology emerging from the close juxtaposition of
  • type II pneumocytes and pulmonary endothelial cells. Semin Immunopathol 2022;44(3):375–390.
  • Views: 808
    PDF downloads: 425
    HTML downloads: 70


    Published: 2022-08-09
    Issue: 2022: Vol 9 No 8 (view)


    How to cite:
    1.
    Lázaro Mendes J, Venade G, Manuel P, Costa Matos L, Nascimento E. Virus and Autoimmunity: Can SARS-CoV-2 Trigger Large Vessel Vasculitis?. EJCRIM 2022;9 doi:10.12890/2022_003486.

    Most read articles by the same author(s)