Department of Pediatrics Hasbro Children's Hospital Warren Alpert Medical School Brown University, 02903, Providence, RI, USA.
Division of Pediatric Pulmonology, Department of Pediatrics Hasbro Children's Hospital Warren Alpert Medical School Brown University, 02903, Providence, RI, USA.
Pediatr Rheumatol Online J. 2022 Aug 13;20(1):65. doi: 10.1186/s12969-022-00727-1.
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare form of vasculitis in children. SARS-CoV-2, the virus that causes COVID-19 infection, seems to trigger autoimmunity and new-onset autoimmune disease in pediatric and adult patients. We present a case of new-onset AAV following COVID-19 infection in an adolescent patient, and we review the literature of AAV following COVID-19 infection.
An adolescent female with a history of asthma was diagnosed with mild COVID-19 infection and subsequently developed persistent cough, wheezing, hearing loss, arthralgias, and rash. Her imaging and laboratory workup showed pulmonary nodules and cavitary lesions, elevated inflammatory markers, negative infectious testing, and positive ANCA. She was treated with glucocorticoids, rituximab, and mycophenolate mofetil. At six-month follow-up, she had improvement in her symptoms, pulmonary function tests, imaging findings, and laboratory markers.
We report the second case of new-onset anti-PR3, C-ANCA vasculitis and the fourth case of pediatric-onset AAV following COVID-19 infection. A systematic review of the literature found 6 cases of new-onset AAV in adults after COVID-19 infection. Pediatric and adult patients who develop AAV post COVID-19 infection have few, if any, comorbidities, and show marked radiographic and symptomatic improvement after treatment. There is increasing evidence for COVID-19-induced autoimmunity in children and our case highlights the importance of considering AAV in a child following a recent COVID-19 infection because timely treatment may improve clinical outcomes.
抗中性粒细胞胞质抗体（ANCA）相关性血管炎（AAV）是儿童中罕见的血管炎形式。导致 COVID-19 感染的 SARS-CoV-2 病毒似乎会引发儿科和成年患者的自身免疫和新发性自身免疫性疾病。我们报告了一例青少年 COVID-19 感染后新发 AAV 的病例，并对 COVID-19 感染后 AAV 的文献进行了综述。
一名有哮喘病史的青少年女性被诊断出患有轻度 COVID-19 感染，随后出现持续性咳嗽、喘息、听力损失、关节痛和皮疹。她的影像学和实验室检查结果显示肺部结节和空洞性病变、炎症标志物升高、阴性感染性检测和阳性 ANCA。她接受了糖皮质激素、利妥昔单抗和霉酚酸酯治疗。在 6 个月的随访中，她的症状、肺功能测试、影像学发现和实验室标志物均有所改善。
我们报告了第二例新发性抗 PR3、C-ANCA 血管炎病例，以及第四例 COVID-19 感染后儿童发病的 AAV 病例。对文献的系统回顾发现，COVID-19 感染后成人新发 AAV 有 6 例。COVID-19 感染后发生 AAV 的儿科和成年患者如果有合并症，也很少，并且在治疗后影像学和症状明显改善。越来越多的证据表明 COVID-19 可诱导儿童发生自身免疫，我们的病例强调了在儿童最近 COVID-19 感染后考虑 AAV 的重要性，因为及时治疗可能会改善临床结局。
