Belozerov Konstantin E, Avrusin Ilia S, Andaryanova Lyubov I, Guseva Anna M, Shogenova Zaira S, Belanovich Irina N, Lobacheva Anna V, Kornishina Tatiana L, Isupova Eugenia A, Masalova Vera V, Kalashnikova Olga V, Nokhrin Andrey V, Panova Tatyana F, Dutova Yulia P, Myshkovskaya Svetlana L, Kostyunin Kirill Y, Komissarov Andrey B, Chasnyk Vyacheslav G, Bregel Liudmila V, Kostik Mikhail M
Hospital Pediatry, Saint Petersburg State Pediatric Medical University, 194100 Saint Petersburg, Russia.
Pediatric Department, Leningrad Regional Children's Clinical Hospital, 195009 Saint Petersburg, Russia.
Biomedicines. 2023 Mar 13;11(3):870. doi: 10.3390/biomedicines11030870.
Several cases of skin and central nervous system vasculopathy associated with COVID-19 in children have been published, but the information is rather limited. Our study aimed to describe these cases of vasculitis associated with COVID-19 in children.
In the retrospective-prospective case series study we included information regarding four children with COVID-19-associated vasculitis. In every case, we had a morphological description and the etiology was confirmed via real-time polymerase chain reaction during a tissue biopsy.
The most involved systems were skin (4/4), respiratory (3/4), cardiovascular (2/4), nervous (1/4), eye (1/4), kidney (1/4), and inner year (1/4). All patients had increased inflammatory markers and thrombotic parameters (D-dimer). No patient met the criteria for multisystem inflammatory syndrome in children. Two patients met polyarteritis nodosa criteria, one met Henoch-Schonlein purpura criteria, and one met unclassified vasculitis criteria. All patients were treated with systemic glucocorticosteroids (two-pulse therapy). Non-biologic DMARDs were prescribed in all cases; 1/4 patients (25%) was treated with intravenous immunoglobuline, and 3/4 (75%) were treated with biologics (etanercept, tocilizumab, and adalimumab).
Vasculitis associated with COVID-19 could be a life-threatening condition; SARS-CoV-2 might be a new trigger or etiological agent for vasculitis and other immune-mediated diseases. Further research and collection of similar cases are required.
已有多篇关于儿童新冠病毒病（COVID-19）相关皮肤和中枢神经系统血管病变的病例报道，但相关信息较为有限。我们的研究旨在描述这些儿童COVID-19相关血管炎病例。
在这项回顾性-前瞻性病例系列研究中，我们纳入了4例COVID-19相关血管炎患儿的信息。每例病例均有形态学描述，病因通过组织活检时的实时聚合酶链反应得以证实。
受累最多的系统为皮肤（4/4）、呼吸系统（3/4）、心血管系统（2/4）、神经系统（1/4）、眼部（1/4）、肾脏（1/4）和内耳（1/4）。所有患者的炎症标志物和血栓形成参数（D-二聚体）均升高。没有患者符合儿童多系统炎症综合征的标准。2例患者符合结节性多动脉炎标准，1例符合过敏性紫癜标准，1例符合未分类血管炎标准。所有患者均接受了全身性糖皮质激素治疗（两疗程冲击治疗）。所有病例均使用了非生物性改善病情抗风湿药；1/4的患者（25%）接受了静脉注射免疫球蛋白治疗，3/4的患者（75%）接受了生物制剂治疗（依那西普、托珠单抗和阿达木单抗）。
COVID-19相关血管炎可能是一种危及生命的疾病；严重急性呼吸综合征冠状病毒2（SARS-CoV-2）可能是血管炎和其他免疫介导疾病的新触发因素或病原体。需要进一步开展研究并收集类似病例。
