RESUMEN
@#Abstract: To report on two patients with Coronavirus Disease 2019 (COVID-19) combined with diffuse connective tissue disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection followed for nearly 3 years, in order to understand the long-term effects on the patients' immune system. Both patients were male, aged 81-82 years, and were hospitalized with fever on January 29, 2020 and February 10, 2020, respectively. Both were diagnosed with COVID-19 after positive SARS-CoV-2 polymerase chain reaction (PCR) tests. After receiving anti-infection treatment, cough suppressants, ex‐pectorants, and symptomatic supportive treatment, their body temperature returned to normal and two consecutive PCR tests were negative for SARS-CoV-2, and they were discharged from hospital. However, due to recurring fevers and varying degrees of rheumatic disease-related symptoms, both patients were readmitted to the hospital, indicating the presence of positive auto‐ antibodies and organ involvement. One patient recovered from COVID-19 with recurrent fever, joint pain, muscle aches and subcutaneous nodules, and was subsequently diagnosed with undifferentiated connective tissue disease. The other patient developed recurrent fever, mouth ulcers and rash after recovery from COVID-19 and was subsequently diagnosed with anti neutro phil cytoplasm antibody (ANCA)-associated vasculitis (AAV). The patient was treated with glucocorticoids and immunosuppres sive drugs and the symptoms resolved rapidly and subsequent laboratory and imaging examinations showed stable condition. However, due to self-termination of medication, their symptoms quickly relapsed, and further treatment with glucocorticoids and immunosuppressive agents resulted in sustained stability of their condition. The erythrocyte sedimentation rate and hyper‐sensitive C-reactive protein remained within normal limits, and lung CT scans showed stable lesions with partial absorption.SARS-CoV-2 infection may have long-term effects on patients' immune systems, leading to abnormal immune responses and diffuse connective tissue disease. This suggests that regular follow-up observation of immune system-related diseases may be necessary for elderly patients with COVID-19.
RESUMEN
Objective This study was aimed to analyze the difference in the clinical features of patients with anti-proteinase-3 anti-neutrophil cytoplasm antibody (PR3-ANCA) and anti-myeloperoxidase (MPO)-ANCA associated vasculitis (AAV);and to discuss the risk factor of relapse.Methods We retrospectively analyzed 103 AAV patients who were diagnosed in Tianjin Medical University General Hospital from January 2010 to May 2016.Based on ANCA serotypes,patients were divided into PR3-ANCA positive,MPO-ANCA positive,both PR3-ANCA and MPO-ANCA negative groups.The difference between the PR3-ANCA and MPO-ANCA groups was analyzed The x2 test and t-test were used for statistical analysis.The Logistic regression analysis was used to evaluate the risk factors of relapse in AAV patients.Results This study included 103 cases of AAV patients,in which,79 (76.7％) patients were with MPO-ANCA and 23 (22.3％) were PR3-ANCA.The MPO-ANCA group had more coronary heart disease than PR3-ANCA group (x2=10.36,P=0.001).The MPO-ANCA group had more pulmonary fibrosis than PR3-ANCA group (x2=12.08,P=0.001).Logistic regres-sion analysis showed that the risk factors of relapse was increase of erythrocyte sedimentation rate (ESR) [OR(95％CI)=9.20(1.06,79.98),P=0.04].Conclusion AAV patients with positive MPO-ANCA and PR3-ANCA are different.
RESUMEN
Anti-neutrophil cytoplasm antibody-associated vasculitis (ANCA) is an autoimmune disease with multi organ involvement characterized by vascular wall inflammation and fibrinoid necrosis, including microscopic polyangitis (MPA), granuloma polyangitis (GPA), and eosinophilic granuloma polyangitis (EGPA). Because its clinical manifestations are complicated and non-speciifc, it is dififcult to make early diagnose. In recent years, some new progress has been made in diagnosis and treatment of this disease. The article will review the related information.