Systemic lupus erythematosus manifestation following COVID-19 infection: A coincidental or causal relation

Abstract

Several intricate interactions of environmental and genetic factors can lead to autoimmune conditions in susceptible hosts. Systemic lupus erythematosus (SLE) is a complex systemic autoimmune disease which can be triggered or exacerbated by infection or infectious reactions. The causal link between infections and autoimmunity has been established through clinical studies. Though several viral infections have been associated with SLE, yet the impact of COVID-19 on SLE onset and flares has not been well established. We report a young female who developed new-onset SLE shortly after having COVID-19 infection. Her clinical and lab parameters were highly suggestive of SLE and she responded to standard medical therapy. We also briefly discuss the pathogenetic mechanisms of autoimmunity in cases of viral infections.

Serositis and lymphopenia are common features of systemic lupus erythematosus following SARS‐CoV‐2 infection: A case report and literature review

“…Despite the higher prevalence of SLE in Asians, Africans, and Hispanics than in Caucasians, 24 the previous reports are only from the United States, France, Morocco, Italy, Mexico, Iran, Egypt, Qatar, and not from the Western Pacific region. [15][16][17][18][19][20][21][22][23] Interestingly, various autoantibodies were detected in our case (anti-nuclear antibody, anti-double-strand DNA antibody, anti-cardiolipin IgG antibody, anti-U1-RNP antibody, anti-SS-B antibody, and anti-CCP antibody). The titers of anti-nuclear and antidouble-strand DNA antibodies were rather low in our case, being consistent with the characteristics of SLE in the elderly.…”

“…The ages of the previous 9 cases were distributed between the ages of 18 and 85, so the current 86‐year‐old case is the oldest. Despite the higher prevalence of SLE in Asians, Africans, and Hispanics than in Caucasians, 24 the previous reports are only from the United States, France, Morocco, Italy, Mexico, Iran, Egypt, Qatar, and not from the Western Pacific region 15–23 …”

“…Rheumatological complications such as inflammatory arthritis, SLE / lupus like syndromes, myositis, vasculitis occurred following SARS-CoV-2 infection. 5,[15][16][17][18][19][20][21][22][23] The precise mechanism is unknown, however, anti-idiotype antibodies induced by SARS-CoV-2 infection might have a role. 13 There are similarities between COVID-19 and SLE.…”

“…SARS‐CoV‐2 infection might trigger various autoimmune/autoinflammatory phenomena. Rheumatological complications such as inflammatory arthritis, SLE / lupus like syndromes, myositis, vasculitis occurred following SARS‐CoV‐2 infection 5,15–23 . The precise mechanism is unknown, however, anti‐idiotype antibodies induced by SARS‐CoV‐2 infection might have a role 13 .…”

“…Further case accumulation and research is needed to elucidate if there is some causative role of SARS-CoV-2 for SLE development. Cases of SLE after or during COVID-19 [15][16][17][18][19][20][21][22][23]. :80), dsDNA Ab+, low C3, lymphopenia, pleuritis Abbreviations: AKI, acute kidney injury; ANA, anti-nuclear antibody; ANCA, anti-neutrophil cytoplasmic antibodies; aPL Ab, anti-phospholipid antibody; C3/C4, complements C3 and C4; dsDNA Ab, anti-double-stranded DNA antibody; SS-A/SS-B Ab, anti-Sjögren's syndrome-A/Sjögren's syndrome-B antibody; N/A, not available; USA, the United States of America.…”