Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Rheumatology, Ankara, Turkey.
Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Rheumatology, Ankara, Turkey.
Semin Arthritis Rheum. 2022 Aug;55:152047. doi: 10.1016/j.semarthrit.2022.152047. Epub 2022 Jun 9.
Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2, has opened a new era in the practice of pediatric rheumatology since it has been associated with inflammatory complications such as vasculitis and arthritis. In this review, we aimed to present a detailed analysis of COVID-19 associated pediatric vasculitis.
A systematic review of the English literature was performed through Pubmed/MEDLINE and Scopus up to January 1st, 2022. Articles including data about the patients with 1) onset of vasculitis <18 years of age, 2) evidence of SARS-CoV-2 exposure, 3) evidence of vasculitis diagnosis (imaging, histopathologic evidences or fulfilling the specific diagnostic/classification criteria) were included in the final analysis. Patients with Kawasaki disease-like vasculitis associated with multisystem inflammatory syndrome in children (MIS-C) were excluded.
A total of 25 articles describing 36 patients with COVID-19 associated pediatric vasculitis (median age 13 years; M/F: 2.3) were included. The most frequent phenotype was IgA vasculitis (n=9) followed by chilblains (n=7) and ANCA associated vasculitis (AAV) (n=5). Skin (58.3%) and renal (30.5%) involvements were the most common manifestations of vasculitis. The majority of patients received corticosteroids (40%), while rituximab (14.2%) and cyclophosphamide (11.4%) were the most frequently used immunosuppressive drugs. Remission was achieved in 23 of 28 patients. Five patients (4 with central nervous system vasculitis; 1 with AAV) died.
Although COVID-19 associated pediatric vasculitis is very rare, awareness of this rare entity is important to secure earlier diagnosis and treatment. The clinical features of COVID-19 associated pediatric vasculitis subtypes look similar to those in pediatric vasculitis not associated with COVID-19. Whether COVID-19 is the reason of the vasculitis or only the trigger remains unknown.
由 SARS-CoV-2 引起的 2019 年冠状病毒病（COVID-19）开创了儿科风湿病实践的新纪元，因为它与血管炎和关节炎等炎症性并发症有关。在本综述中，我们旨在对 COVID-19 相关儿科血管炎进行详细分析。
通过 Pubmed/MEDLINE 和 Scopus 对截至 2022 年 1 月 1 日的英文文献进行系统回顾。纳入的文章包括以下数据：1）发病年龄<18 岁的血管炎患者；2）有 SARS-CoV-2 暴露证据；3）有血管炎诊断证据（影像学、组织病理学证据或符合特定诊断/分类标准）。排除与儿童多系统炎症综合征（MIS-C）相关的川崎病样血管炎患者。
共纳入 25 篇描述 36 例 COVID-19 相关儿科血管炎患者的文章（中位年龄 13 岁；M/F：2.3）。最常见的表型为 IgA 血管炎（n=9），其次为冻疮样皮疹（n=7）和抗中性粒细胞胞质抗体（ANCA）相关血管炎（n=5）。皮肤（58.3%）和肾脏（30.5%）受累是血管炎最常见的表现。大多数患者接受了皮质类固醇（40%）治疗，而利妥昔单抗（14.2%）和环磷酰胺（11.4%）是最常使用的免疫抑制剂。28 例患者中有 23 例达到缓解。5 例患者（4 例中枢神经系统血管炎；1 例 ANCA 相关血管炎）死亡。
尽管 COVID-19 相关儿科血管炎非常罕见，但认识到这种罕见实体对于确保早期诊断和治疗很重要。COVID-19 相关儿科血管炎各亚型的临床特征与非 COVID-19 相关儿科血管炎相似。COVID-19 是否是血管炎的病因或仅是触发因素尚不清楚。
