COVID-19: Infection or Autoimmunity

Front Immunol. 2020 Sep 11;11:2055. doi: 10.3389/fimmu.2020.02055. eCollection 2020.


The clinical and laboratory features of COVID-19 are reviewed with attention to the immunologic manifestations of the disease. Recent COVID-19 publications describe a variety of clinical presentations including an asymptomatic state, pneumonia, a hemophagocytic lymphohistiocytosis like syndrome, Multisystem Inflammatory Syndrome in Children (MIS-C) but, also called Pediatric Inflammatory Multisystem Syndrome-Toxic Shock (PIMS-TS), Kawasaki Disease, and myocarditis. A common theme amongst multiple reports suggests an overexuberant autoimmune component of the disease but a common pathophysiology to explain the variations in clinical presentation has been elusive. Review of the basic science of other viral induced autoimmune disorders may give clues as to why immunosuppressive and immunomodulating regimens now appear to have some efficacy in COVID-19. Review of the immunopathology also reveals other therapies that have yet to be explored. There is potential use of T cell depleting therapies and possibly anti-CD20 therapy for COVID-19 and clinical research using these medications is warranted.

Keywords: COVID-19; autoimmunity; hemophagocytic lymphohistiocytosis; immunosuppression; myocarditis; rituximab; thymoglobulin.

Publication types

  • Review

MeSH terms

  • Betacoronavirus / immunology*
  • Child
  • Child, Preschool
  • Coronavirus Infections* / immunology
  • Coronavirus Infections* / pathology
  • Coronavirus Infections* / therapy
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Lymphocyte Depletion*
  • Lymphohistiocytosis, Hemophagocytic / immunology
  • Lymphohistiocytosis, Hemophagocytic / pathology
  • Lymphohistiocytosis, Hemophagocytic / therapy
  • Lymphohistiocytosis, Hemophagocytic / virology
  • Mucocutaneous Lymph Node Syndrome / immunology
  • Mucocutaneous Lymph Node Syndrome / pathology
  • Mucocutaneous Lymph Node Syndrome / therapy
  • Mucocutaneous Lymph Node Syndrome / virology
  • Myocarditis / immunology
  • Myocarditis / therapy
  • Myocarditis / virology
  • Pandemics*
  • Pneumonia, Viral* / immunology
  • Pneumonia, Viral* / pathology
  • Pneumonia, Viral* / therapy
  • Systemic Inflammatory Response Syndrome* / immunology
  • Systemic Inflammatory Response Syndrome* / pathology
  • Systemic Inflammatory Response Syndrome* / therapy
  • Systemic Inflammatory Response Syndrome* / virology
  • T-Lymphocytes* / immunology
  • T-Lymphocytes* / pathology


  • Immunosuppressive Agents

Supplementary concepts

  • COVID-19
  • pediatric multisystem inflammatory disease, COVID-19 related
  • severe acute respiratory syndrome coronavirus 2