Pediatric P-ANCA vasculitis following COVID-19

Yaron Fireizen; Cyrus Shahriary; Maria E Imperial; Inderpal Randhawa; Nastasia Nianiaris; Bugsu Ovunc

doi:10.1002/ppul.25612

Pediatric P-ANCA vasculitis following COVID-19

Pediatr Pulmonol. 2021 Oct;56(10):3422-3424. doi: 10.1002/ppul.25612. Epub 2021 Aug 11.

Authors

Yaron Fireizen^{1

2}, Cyrus Shahriary^{1

2}, Maria E Imperial^{1

2}, Inderpal Randhawa^{1

2}, Nastasia Nianiaris^{1

2}, Bugsu Ovunc^{1

2}

Affiliations

¹ Pulmonary Division, Memorial Care Miller Children's & Women's Hospital, Long Beach, California, USA.
² School of Medicine, University of California, Irvine, California, USA.

Abstract

Background: Perinuclear anti-neutrophil cytoplasmic antibodies (P-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 have been reported. Although SARS-CoV-2 has been shown to drive an exaggerated immune response in the pediatric population, such as in Multisystem Inflammatory Syndrome in Children (MIS-C), only one case of vasculitis following COVID-19 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 and diffuse alveolar hemorrhage. Rheumatologic workup revealed P-ANCA and Myeloperoxidase (MPO) positivity. Kidney biopsy showed necrotizing glomerulonephritis with limited immune complex deposition. Subsequently, he was treated with steroids and 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.

Keywords: COVID-19; P-ANCA vasculitis; diffuse alveolar hemorrhage.

Publication types

Case Reports

MeSH terms

Adolescent
Adult
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / complications
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / diagnosis
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / drug therapy
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / immunology*
Antibodies, Antineutrophil Cytoplasmic
COVID-19 / diagnosis
COVID-19 / immunology*
COVID-19 / virology
Child
Humans
Male
Peroxidase
SARS-CoV-2 / immunology*
SARS-CoV-2 / pathogenicity
Systemic Inflammatory Response Syndrome*
Treatment Outcome
Vasculitis* / diagnosis
Vasculitis* / etiology

Substances

Antibodies, Antineutrophil Cytoplasmic
Peroxidase

Supplementary concepts

pediatric multisystem inflammatory disease, COVID-19 related