Pediatric P-ANCA Vasculitis following COVID-19

Abstract

Background: Perinuclear anti-neutrophil cytoplasmic antibodies (P-ANCA), a subset of ANCA, are associated with a multisystem vasculitis affecting small blood vessels in the body. A handful of adult patients who developed vasculitis post-COVID-19 infection have been reported. Although COVID-19 infection has been shown to drive an exaggerated immune response in the pediatric population, such as MIS-C (multisystem inflammatory syndrome in children), only one case of vasculitis following COVID-19 infection has been reported previously in children. Case presentation: Seventeen-year-old male with a past medical history of COVID-19 pneumonia two months prior presented with acute kidney injury/failure and diffuse alveolar hemorrhage (DAH). Rheumatologic workup revealed P-ANCA and Myeloperoxidase (MPO) positivity. Kidney biopsy showed necrotizing glomerulonephritis with limited immune complex deposition. Subsequently, he was treated with pulse steroids, plasmapheresis, and ultimately started on cyclophosphamide. Conclusions: To our knowledge, this report presents the second reported pediatric case of P-ANCA / MPO vasculitis following COVID-19 infection.

Pathogenesis and histological changes of nephropathy associated with COVID‐19

“…108 Some patients developed hemolytic urine syndrome and antineutrophil cytoplasmic antibodies (ANCA)-related vasculitis. [109][110][111] In addition, the mutated SARS-CoV-2 virus also has the risk of causing kidney injury. Gabriella reported a case of a Covid-19 Delta variant positive patient with diffuse thromboembolic disease, including right renal artery thrombosis.…”

Cerebrovascular Complications in Pediatric Patients with COVID-19 Infection

“…Proposed mechanisms include hyperstimulation of the immune system and loss of immune tolerance during the subsequent transient weakening of the immune system. [42][43][44]…”

“…3,22,23,31,37,38,40,41 Autoimmune-mediated effects have been described in association with COVID-19, although primarily in the adult population, with reports of postinfectious development of new autoimmune diseases, including systemic lupus erythematosus, autoimmune hemolytic anemia, and rheumatoid arthritis. [42][43][44] To a lesser extent, the development of new autoimmune disease following COVID-19 infection has also been seen in children, particularly systemic vasculitides. [42][43][44] An underlying autoimmune component is suggested, although the pathophysiology is poorly understood.…”

“…[42][43][44] To a lesser extent, the development of new autoimmune disease following COVID-19 infection has also been seen in children, particularly systemic vasculitides. [42][43][44] An underlying autoimmune component is suggested, although the pathophysiology is poorly understood. Proposed mechanisms include hyperstimulation of the immune system and loss of immune tolerance during the subsequent transient weakening of the immune system.…”

Commentary: Hematuria as an early sign of multisystem inflammatory syndrome in children: A case report of a boy with multiple comorbidities and a review of the literature

“…• Some aspects of the case report suggest a possible underlying nephrological disease as comorbidity. It is known that acute Sars-Cov-2 infection may trigger an underlying disease to manifest clinically (17,21). IgA nephropathy manifests with periodic macrohematuria with spontaneous remission.…”