COVID-19 and eosinophilic granulomatosis with polyangiitis or COVID-19 mimicking eosinophilic granulomatosis with polyangiitis?

Abstract

Coronavirus disease 2019 (COVID-19) and eosinophilic granulomatosis with polyangiitis (EGPA) share similarities in clinical, imaging findings and may present with respiratory distress. Differentiating a new-onset EGPA from COVID-19 during the current pandemic is a diagnostic challenge, particularly if other EGPA symptoms are overlooked. Here in this study we reviewed the literature regarding EGPA patients with COVID-19 and patients who diagnosed with EGPA or suffered an EGPA flare mimicking COVID-19. We conducted a literature survey in PUBMED database using meshed keywords "COVID-19" and "EGPA", "COVID-19" and "eosinophilic granulomatosis with polyangiitis", "COVID-19" and "Churg Strauss Syndrome", to reveal previously reported cases involving EGPA patients who had COVID-19 infection, patients who suspected to have COVID-19 but eventually diagnosed with EGPA and patients with a known diagnosis of EGPA who suffered a flare but a COVID-19 infection was suspected initially. A total of 11 cases (6 literature cases, 5 cases from our clinic) were included in our study. Seven (63.6%) of the cases were defined as COVID-19 mimicker and 4 (36.4%) were EGPA with COVID-19. All of the cases in EGPA with COVID-19 group had a history of asthma. All of them had a positive PCR result and ground-glass opacities in thorax CT. In COVID-19 mimicker group, six (85.7%) patients had a history of asthma and other EGPA features that were observed were eosinophilia in 6 (85.7%). Our study provided clues regarding the EGPA/ COVID-19 diagnostic challenge which may be useful in the current pandemic. Since none of the findings in COVID-19 are disease-specific, other conditions like EGPA should not be overlooked particularly in PCR negative patients and clinical, laboratory and imaging findings should be interpreted carefully. Furthermore, we did not observe poor outcomes in EGPA patients who had COVID-19.

Eosinophilic granulomatosis with polyangiitis after COVID-19: A case report

“…However, there is no strong evidence about the role of SARS-CoV-2 in the pathophysiology of vasculitis. EGPA and COVID-19 share common symptoms and some EGPA patients mimic COVID-19 features, which makes it challenging to distinguish them from each other [ 15 ]. So far, there is no report of EGPA after COVID-19 recovery and our report is the first one.…”

Antineutrophil Cytoplasmic Antibody Positivity and Clinical Implications in COVID-19

“…Several reports imply a relation between COVID-19 infection and development of new onset AAV [ 15–18 ]. Furthermore, COVID-19 and AAV share some similar features, particularly regarding pulmonary involvement, which seemingly created a diagnostic challenge for AAV during the pandemic [ 19–21 ]. In our study, presence of hematuria (43.0% vs 75.0%; p = 0.084) and alveolar hemorrhage reported in thorax CT (1.3% vs 12.5%; p = 0.045) were observed to be increased in ANCA-positive patients which may be indicative of a vasculitic process.…”

“…In our study, presence of hematuria (43.0% vs 75.0%; p = 0.084) and alveolar hemorrhage reported in thorax CT (1.3% vs 12.5%; p = 0.045) were observed to be increased in ANCA-positive patients which may be indicative of a vasculitic process. None of our ANCA-positive patients had eosinophilia, which could have been indicative of eosinophilic granulomatosis with polyangiitis development [ 19 ]. Moreover, histopathologic evaluation did not reveal a vasculitic involvement in the ANCA-positive patient who underwent renal biopsy in our study and none of the patients, in whom alveolar hemorrhage was reported in imaging, underwent bronchoalveolar lavage for confirmation.…”

Managing ANCA-associated vasculitis during the COVID-19 pandemic: results from an online survey

“…The timing of rituximab in AAV in the context of COVID-19 vaccines requires a balancing of risk–benefit ratio considering that humoral immune responses to COVID-19 vaccines could be dampened if such vaccines are administered in close proximity to the timing of rituximab [ 24 ]. The emergence of AAV following COVID-19 or AAV mimicking COVID-19 is also being increasingly recognized [ 25 , 26 ]. This clinical situation poses a further challenge for the management of patients with AAV during the COVID-19 pandemic.…”