A Periaortitis Patient Who Succumbed to COVID-19 While Undergoing Systemic Steroid Therapy: A Case Report and Literature Review.

ABSTRACT

BACKGROUND Periaortitis is an inflammatory condition that typically involves the infrarenal portion of the abdominal aorta. It is a rare disease usually occurring in middle-aged men. Coronavirus disease-2019 (COVID-19) is caused by the SARS-CoV-2 virus. The published literature on the management of steroid therapy in patients with periaortitis and infected with SARS-CoV-2 is lacking. The balance between the indispensable anti-inflammatory properties of steroids and their adverse immunosuppressive characteristics remains unclear in the current COVID-19 scenario, and most of the current practices in managing potentially autoimmune aortic conditions are extrapolated from patients with rheumatological disorders contracting COVID19 while undergoing maintenance steroid therapy. CASE REPORT This report describes the case of a 62-year-old man who presented with nonspecific lower abdominal pain, unremarkable clinical exam, significantly elevated CRP level, and positive antinuclear antibody test. A CT scan showed mild aortic aneurysmal dilatation with periaortic soft tissue thickening, and a PET scan confirmed the finding, showing active abdominal periaortitis. Accordingly, he was diagnosed with autoimmune periaortitis and was maintained on a high dose of systemic corticosteroids (35 mg prednisolone/d). Eight weeks later, he was readmitted to the intensive care unit with worsening respiratory symptoms due to SARS-CoV-2 infection confirmed by PCR test, and unfortunately died 44 days later due to COVID-19-induced respiratory failure and sepsis. CONCLUSIONS The lack of an international consensus on the management of SARS-CoV-2-positive, steroid-dependent patients with serious inflammatory aortic conditions mandates further investigations and thoughtful review of the guidelines for the management of steroid-dependent patients contracting SARS-CoV-2 infection. Additionally, a comprehensive analysis of the outcomes of these patients is essential.