A pediatric case of Takayasu's arteritis with anti-neutrophil cytoplasmic antibody-associated vasculitis triggered by COVID-19 infection.
Anti-neutrophil cytoplasmic antibody-associated vasculitis
Takayasu’s arteritis
coronavirus disease 2019
rheumatology
Journal
Northern clinics of Istanbul
ISSN: 2536-4553
Titre abrégé: North Clin Istanb
Pays: Turkey
ID NLM: 101684520
Informations de publication
Date de publication:
2023
2023
Historique:
received:
27
01
2022
revised:
28
02
2022
accepted:
13
03
2022
medline:
12
7
2023
pubmed:
12
7
2023
entrez:
12
7
2023
Statut:
epublish
Résumé
Takayasu's arteritis (TA) is a rare chronic granulomatous vasculitis characterized by large-vessel involvement. The aorta and its main branches are most commonly involved. Although pulmonary artery involvement is common, hemoptysis or respiratory findings are rarely seen. Herein, we present a case of TA who developed anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis with diffuse alveolar hemorrhage after coronavirus disease 2019 (COVID-19) infection. A 17-year-old female patient with the diagnosis of TA presented with cough, bloody vomiting, and diarrhea. In follow-up, she developed tachypnea and dyspnea and was transferred to the pediatric intensive care unit. The findings on the chest computed tomography were compatible with acute COVID-19 infection, but the SARS-CoV2 reverse transcription-polymerase chain reaction test was negative, but SARS-CoV2 immunoglobulin (Ig) G and IgM antibody tests were positive. The patient was not vaccinated against COVID-19. The bronchoscopy showed bronchial mucosal fragility, bleeding foci, and mucosal bleeding. The broncoalveolar lavage hemosiderin-laden macrophages were seen in the histopathologic examination. The indirect immunofluorescence assay-ANCA test became 3 (+) with myeloperoxidase (MPO)-ANCA of 125 RU/ml (normal: <20). Cyclophosphamide and pulse steroid treatment were started. After immunosuppressive therapy, the patient condition improved and did not have hemoptysis again. The successful response was obtained by applying balloon angioplasty to the patient with bilateral renal artery stenosis. Types of post-COVID vasculitis include thromboembolic events, cutaneous vasculitis, Kawasaki-like vasculitis, myopericarditis, and ANCA-associated vasculitis. It is thought that COVID-19 may impair immune tolerance and trigger autoimmunity with cross-reaction. To the best of our knowledge, the third pediatric case was reported with MPO-ANCA-positive COVID-associated ANCA vasculitis.
Identifiants
pubmed: 37435294
doi: 10.14744/nci.2022.01878
pii: NCI-10-393
pmc: PMC10331244
doi:
Types de publication
Case Reports
Langues
eng
Pagination
393-397Informations de copyright
© Copyright 2023 by Istanbul Provincial Directorate of Health.
Déclaration de conflit d'intérêts
No conflict of interest was declared by the authors.
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