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1.
BMC Infect Dis ; 21(1): 958, 2021 Sep 16.
Article in English | MEDLINE | ID: covidwho-1496148

ABSTRACT

BACKGROUND: Cases of immune complex vasculitis have been reported following COVID-19 infections; so far none in association with novel mRNA-based COVID-19 vaccination. This case report describes a cutaneous immune complex vasculitis after vaccination with BNT162b2. CASE PRESENTATION: A 76-year old male with liver cirrhosis developed an immune complex vasculitis 12 days after the second injection of BNT162b2. On physical examination, the patient presented with pruritic purpuric macules on hands and feet, flexor and extensor parts of both legs and thighs and lower abdomen, and bloody diarrhoea. Laboratory testing showed elevated inflammatory markers. After short treatment with oral steroids all clinical manifestations and laboratory findings resolved. CONCLUSIONS: An increasing number of clinical manifestations have been attributed to COVID-19 infection and vaccination. This is the first written report of immune complex vasculitis after vaccination with BNT162b2. We present our case report and a discussion in the light of type three hypersensitivity reaction.


Subject(s)
COVID-19 , Vasculitis , Aged , Antigen-Antibody Complex , COVID-19 Vaccines , Humans , Male , SARS-CoV-2 , Vaccination/adverse effects , Vasculitis/diagnosis , Vasculitis/etiology
2.
Pediatr Pulmonol ; 56(10): 3422-3424, 2021 10.
Article in English | MEDLINE | ID: covidwho-1351269

ABSTRACT

BACKGROUND: Perinuclear anti-neutrophil cytoplasmic antibodies (P-ANCA) are associated with a multisystem vasculitis affecting small blood vessels in the body. A handful of adult patients who developed vasculitis post-COVID-19 have been reported. Although SARS-CoV-2 has been shown to drive an exaggerated immune response in the pediatric population, such as in Multisystem Inflammatory Syndrome in Children (MIS-C), only one case of vasculitis following COVID-19 has been reported previously in children. CASE PRESENTATION: Seventeen-year-old male with a past medical history of COVID-19 pneumonia two months prior presented with acute kidney injury and diffuse alveolar hemorrhage. Rheumatologic workup revealed P-ANCA and Myeloperoxidase (MPO) positivity. Kidney biopsy showed necrotizing glomerulonephritis with limited immune complex deposition. Subsequently, he was treated with steroids and plasmapheresis, and ultimately started on cyclophosphamide. CONCLUSIONS: To our knowledge, this report presents the second reported pediatric case of P-ANCA/MPO vasculitis following COVID-19.


Subject(s)
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/immunology , COVID-19/immunology , SARS-CoV-2/immunology , Systemic Inflammatory Response Syndrome , Vasculitis , Adolescent , Adult , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/complications , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosis , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/drug therapy , Antibodies, Antineutrophil Cytoplasmic , COVID-19/diagnosis , COVID-19/virology , Child , Humans , Male , Peroxidase , SARS-CoV-2/pathogenicity , Treatment Outcome , Vasculitis/diagnosis , Vasculitis/etiology
5.
Int J Mol Sci ; 22(14)2021 Jul 14.
Article in English | MEDLINE | ID: covidwho-1323262

ABSTRACT

IgA, previously called Henoch-Schönlein vasculitis, is an essential immune component that drives the host immune response to the external environment. As IgA has the unique characteristic of a flexible response to broad types of microorganisms, it sometimes causes an autoreactive response in the host human body. IgA vasculitis and related organ dysfunction are representative IgA-mediated autoimmune diseases; bacterial and viral infections often trigger IgA vasculitis. Recent drug developments and the presence of COVID-19 have revealed that these agents can also trigger IgA vasculitis. These findings provide a novel understanding of the pathogenesis of IgA vasculitis. In this review, we focus on the characteristics of IgA and symptoms of IgA vasculitis and other organ dysfunction. We also mention the therapeutic approach, biomarkers, novel triggers for IgA vasculitis, and epigenetic modifications in patients with IgA vasculitis.


Subject(s)
Biomarkers/analysis , Epigenesis, Genetic , Immunoglobulin A/metabolism , Vasculitis/therapy , Animals , Humans , Vasculitis/diagnosis , Vasculitis/etiology , Vasculitis/metabolism
6.
Clin Med (Lond) ; 21(1): e118, 2021 01.
Article in English | MEDLINE | ID: covidwho-1314953
7.
JCI Insight ; 6(13)2021 07 08.
Article in English | MEDLINE | ID: covidwho-1305529

ABSTRACT

The emergence of the novel SARS coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), has resulted in an unprecedented pandemic that has been accompanied by a global health crisis. Although the lungs are the main organs involved in COVID-19, systemic disease with a wide range of clinical manifestations also develops in patients infected with SARS-CoV-2. One of the major systems affected by this virus is the cardiovascular system. The presence of preexisting cardiovascular disease increases mortality in patients with COVID-19, and cardiovascular injuries, including myocarditis, cardiac rhythm abnormalities, endothelial cell injury, thrombotic events, and myocardial interstitial fibrosis, are observed in some patients with COVID-19. The underlying pathophysiology of COVID-19-associated cardiovascular complications is not fully understood, although direct viral infection of myocardium and cytokine storm have been suggested as possible mechanisms of myocarditis. In this Review, we summarize available data on SARS-CoV-2-related cardiac damage and discuss potential mechanisms of cardiovascular implications of this rapidly spreading virus.


Subject(s)
COVID-19/complications , Cardiovascular Diseases/etiology , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/etiology , COVID-19/drug therapy , Cardiovascular Diseases/diagnosis , Fibrosis/diagnosis , Fibrosis/etiology , Humans , Myocarditis/diagnosis , Myocarditis/etiology , Primary Dysautonomias/diagnosis , Primary Dysautonomias/etiology , Thrombosis/diagnosis , Thrombosis/etiology , Vasculitis/diagnosis , Vasculitis/etiology
10.
Rheumatology (Oxford) ; 60(1): 34-47, 2021 01 05.
Article in English | MEDLINE | ID: covidwho-1093595

ABSTRACT

While prompt diagnosis of vasculitis is important, recognition of vasculitis mimics is equally essential. As in the case of vasculitis, an approach to mimics based on the anatomic size of vessels can be useful. Infections can mimic vasculitis of any vessel size, including the formation of aneurysms and induction of ANCAs. Genetic disorders and vasculopathies are important considerations in large and medium vessel vasculitis. Cholesterol emboli, thrombotic conditions and calciphylaxis typically affect the medium and small vessels and, like vasculitis, can cause cutaneous, renal and CNS manifestations. Reversible cerebral vasoconstriction syndrome is important to distinguish from primary angiitis of the CNS. As an incorrect diagnosis of vasculitis can result in harmful consequences, it is imperative that the evaluation of suspected vasculitis includes consideration of mimics. We discuss the above mimics and outline a systematic and practical approach for differentiating vasculitis from its mimics.


Subject(s)
Vasculitis/diagnosis , Diagnosis, Differential , Embolism, Cholesterol/diagnosis , Endocarditis/diagnosis , Humans , Thrombophilia/diagnosis
15.
J Thromb Thrombolysis ; 50(3): 499-511, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-662425

ABSTRACT

The COVID-19 pandemic now totaling 13,000,000 cases and over 571,000 deaths has continued to teach the medical, scientific and lay communities about viral infectious disease in the modern era. Among the many lessons learned for the medical community is the potential for transmissibility and host infectivity of the SARS-CoV-2 virus. Moreover, it has become clear that the virus can affect any organ including the circulatory system, directly via either tissue tropism or indirectly stemming from inflammatory responses in the form of innate immunity, leukocyte debris such as cell-free DNA and histones and RNA viral particles. The following review considers COVID-19-associated vasculitis and vasculopathy as a defining feature of a virus-induced systemic disease with acute, subacute and potential chronic health implications.


Subject(s)
Betacoronavirus/pathogenicity , Blood Vessels/virology , Coronavirus Infections/virology , Pneumonia, Viral/virology , Vasculitis/virology , Animals , Betacoronavirus/immunology , Blood Coagulation , Blood Vessels/immunology , Blood Vessels/pathology , Blood Vessels/physiopathology , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/immunology , Coronavirus Infections/physiopathology , Host-Pathogen Interactions , Humans , Inflammation Mediators/blood , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/immunology , Pneumonia, Viral/physiopathology , Prognosis , Risk Factors , SARS-CoV-2 , Vasculitis/diagnosis , Vasculitis/immunology , Vasculitis/physiopathology
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