A pediatric case of Takayasu's arteritis with anti-neutrophil cytoplasmic antibody-associated vasculitis triggered by COVID-19 infection

Sengul Caglayan; Gulcin Otar Yener; Kadir Ulu; Taner Coskuner; Meryem Guzel; Sevinc Kalin; Hakan Yazan; Seher Erdogan; Mustafa Cakan; Betul Sozeri

doi:10.14744/nci.2022.01878

A pediatric case of Takayasu's arteritis with anti-neutrophil cytoplasmic antibody-associated vasculitis triggered by COVID-19 infection

North Clin Istanb. 2023 Jun 6;10(3):393-397. doi: 10.14744/nci.2022.01878. eCollection 2023.

Authors

Affiliations

¹ Department of Pediatric Rheumatology, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkiye.
² Department of Pediatric Rheumatology, Sanliurfa Training and Research Hospital, Sanliurfa, Turkiye.
³ Department of Pediatric Radiology, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkiye.
⁴ Department of Pediatric Pulmonology, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkiye.
⁵ Department of Pediatric Intensive Care, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkiye.

Abstract

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.

Keywords: Anti-neutrophil cytoplasmic antibody-associated vasculitis; Takayasu’s arteritis; coronavirus disease 2019; rheumatology.

Publication types

Case Reports