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COVID-19 Vasculitis and vasculopathy-Distinct immunopathology emerging from the close juxtaposition of Type II Pneumocytes and Pulmonary Endothelial Cells.
Giryes, Sami; Bragazzi, Nicola Luigi; Bridgewood, Charles; De Marco, Gabriele; McGonagle, Dennis.
  • Giryes S; Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK.
  • Bragazzi NL; Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK.
  • Bridgewood C; Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK.
  • De Marco G; Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK.
  • McGonagle D; Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK. d.g.mcgonagle@leeds.ac.uk.
Semin Immunopathol ; 44(3): 375-390, 2022 05.
Article in English | MEDLINE | ID: covidwho-1782786
ABSTRACT
The SARS-CoV-2 virus ACE-2 receptor utilization for cellular entry and the defined ACE-2 receptor role in cardiovascular medicine hinted at dysregulated endothelial function or even direct viral endotheliitis as the key driver of severe COVID-19 vascular immunopathology including reports of vasculitis. In this article, we critically review COVID-19 immunopathology from the vasculitis perspective and highlight the non-infectious nature of vascular endothelial involvement in severe COVID-19. Whilst COVID-19 lung disease pathological changes included juxta-capillary and vascular macrophage and lymphocytic infiltration typical of vasculitis, we review the evidence reflecting that such "vasculitis" reflects an extension of pneumonic inflammatory pathology to encompass these thin-walled vessels. Definitive, extrapulmonary clinically discernible vasculitis including cutaneous and cardiac vasculitis also emerged- namely a dysregulated interferon expression or "COVID toes" and an ill-defined systemic Kawasaki-like disease. These two latter genuine vasculitis pathologies were not associated with severe COVID-19 pneumonia. This was distinct from cutaneous vasculitis in severe COVID-19 that demonstrated pauci-immune infiltrates and prominent immunothrombosis that appears to represent a novel immunothrombotic vasculitis mimic contributed to by RNAaemia or potentially diffuse pulmonary venous tree thrombosis with systemic embolization with small arteriolar territory occlusion, although the latter remains unproven. Herein, we also performed a systematic literature review of COVID-19 vasculitis and reports of post-SARS-CoV-2 vaccination related vasculitis with respect to the commonly classified pre-COVID vasculitis groupings. Across the vasculitis spectrum, we noted that Goodpasture's syndrome was rarely linked to natural SARS-CoV-2 infection but not vaccines. Both the genuine vasculitis in the COVID-19 era and the proposed vasculitis mimic should advance the understanding of both pulmonary and systemic vascular immunopathology.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Vasculitis / COVID-19 Type of study: Prognostic study / Reviews / Systematic review/Meta Analysis Topics: Vaccines Limits: Humans Language: English Journal: Semin Immunopathol Journal subject: Allergy and Immunology / Pathology Year: 2022 Document Type: Article Affiliation country: S00281-022-00928-6

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Vasculitis / COVID-19 Type of study: Prognostic study / Reviews / Systematic review/Meta Analysis Topics: Vaccines Limits: Humans Language: English Journal: Semin Immunopathol Journal subject: Allergy and Immunology / Pathology Year: 2022 Document Type: Article Affiliation country: S00281-022-00928-6