Autoimmune diseases post‐COVID 19 infection in children in intensive care unit: A case series

Abstract

SARS‐CoV2 primarily affects the respiratory system but a hyperinflammatory response leading to multisystem inflammatory syndrome – children (MIS‐C), immune dysfunction and various autoimmune manifestations has also been noted. Autoimmunity depends on various factors, including genetic predisposition, environmental factors, immune dysregulation and infections acting as triggers like Epstein‐Barr virus, cytomegalovirus, human immunodeficiency virus, hepatitis B. Molecular mimicry, bystander T‐cell activation and persistence of viral infection are the main mechanisms behind these manifestations. We present here 3 cases of newly diagnosed connective tissue disease with high titers of COVID19 immunoglobulin G antibody in children. A 9‐year‐old girl with fever, oliguria and malar rash (prior history of sore throat) and a 10‐year‐old girl with fever for 2 weeks and choreoathetoid movements were diagnosed as systemic lupus erythematosus (SLE) nephritis (stage 4) and neuropsychiatric SLE, respectively as per European League Against Rheumatism / American College of Rheumatology 2019 criteria. An 8‐year‐old girl with fever, joint pain and respiratory distress (a recent contact with a positive COVID19 patient) presented with altered sensorium, Raynaud's phenomenon noted, and eventually diagnosed as mixed connective tissue disease as per Kusukawa criteria. The immune‐mediated manifestations post‐COVID infection are a de‐novo phenomenon which necessitates further workup as not many studies exist in the pediatric population.