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. 2022 Aug 9;9(8):003486.
doi: 10.12890/2022_003486. eCollection 2022.

Virus and Autoimmunity: Can SARS-CoV-2 Trigger Large Vessel Vasculitis?

João Lázaro Mendes  1 , Gabriela Venade  1 , Paula Manuel  1 , Luís Costa Matos  1   2 , Edite Nascimento  1
Affiliations

Virus and Autoimmunity: Can SARS-CoV-2 Trigger Large Vessel Vasculitis?

João Lázaro Mendes et al. Eur J Case Rep Intern Med. .

Abstract

Introduction: Viral infections can induce autoimmune diseases in susceptible patients. SARS-CoV-2 has been associated with the development of rheumatic disease, especially small vessel vasculitis and arthritis. Typically, onset occurs days to weeks after the antigenic challenge and in patients with mild COVID-19. We report a case of large vessel vasculitis (LVV) temporally related to SARS-CoV-2 infection.

Case description: An otherwise healthy 19-year-old woman presented with fatigue, malaise, and chest and low back pain. The symptoms had begun 5 weeks earlier and 1 month after mild SARS-CoV-2 infection. Serological work-up revealed a marked proinflammatory state and anaemia without signs of infectious or autoimmune disease. Computerized tomography revealed thickening and blurring of the perivascular fat of the descending thoracic and abdominal aorta, progressing along the proximal iliac and renal arteries. Fluorodeoxyglucose positron emission tomography confirmed inflammatory activity. Symptoms and laboratory values normalized after prednisolone treatment.

Discussion: Recent SARS-CoV-2 infection may be a trigger for LVV, including Takayasu arteritis, as well as other rheumatic diseases. A prompt and thorough differential diagnosis is essential to exclude aortitis and LVV mimickers. Moreover, physicians should be aware of the potential spectrum of systemic and autoimmune diseases that could be precipitated by SARS-CoV-2 infection. This will allow timely diagnosis and treatment, with significant improvement in prognosis.

Learning points: SARS-CoV-2 infection can trigger large vessel vasculitis and other rheumatic diseases.Awareness of the association between COVID-19 and autoimmune phenomena allows for timely diagnosis and treatment with significant improvements in prognosis.Vasculitis and other autoimmune diseases should be kept in mind in patients who develop proinflammatory states days to weeks after an initial antigenic challenge.

Keywords: Autoimmune diseases; COVID-19; case report; vasculitis.

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Conflict of interest statement

Conflicts of Interests: The authors declare there are no competing interests.

Figures

Figure 1
Figure 1
Contrast CT showing increased thickness of the descending thoracic aorta associated with a clear blurring of perivascular fat.
Figure 2
Figure 2
Contrast CT showing both renal arteries affected, especially in relation to their proximal third.
Figure 3
Figure 3
FDG-PET/CT showing increased uptake in the descending thoracic aorta.
Figure 4
Figure 4
FDG-PET/CT showing increased uptake in the descending thoracic aorta.
Figure 5
Figure 5
Disease work-up, course and treatment response.
See this image and copyright information in PMC

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