Abstract
Objectives: Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2, has opened a new era in the practice of pediatric rheumatology since it has been associated with inflammatory complications such as vasculitis and arthritis. In this review, we aimed to present a detailed analysis of COVID-19 associated pediatric vasculitis.
Methods: A systematic review of the English literature was performed through Pubmed/MEDLINE and Scopus up to January 1st, 2022. Articles including data about the patients with 1) onset of vasculitis <18 years of age, 2) evidence of SARS-CoV-2 exposure, 3) evidence of vasculitis diagnosis (imaging, histopathologic evidences or fulfilling the specific diagnostic/classification criteria) were included in the final analysis. Patients with Kawasaki disease-like vasculitis associated with multisystem inflammatory syndrome in children (MIS-C) were excluded.
Results: A total of 25 articles describing 36 patients with COVID-19 associated pediatric vasculitis (median age 13 years; M/F: 2.3) were included. The most frequent phenotype was IgA vasculitis (n=9) followed by chilblains (n=7) and ANCA associated vasculitis (AAV) (n=5). Skin (58.3%) and renal (30.5%) involvements were the most common manifestations of vasculitis. The majority of patients received corticosteroids (40%), while rituximab (14.2%) and cyclophosphamide (11.4%) were the most frequently used immunosuppressive drugs. Remission was achieved in 23 of 28 patients. Five patients (4 with central nervous system vasculitis; 1 with AAV) died.
Conclusion: Although COVID-19 associated pediatric vasculitis is very rare, awareness of this rare entity is important to secure earlier diagnosis and treatment. The clinical features of COVID-19 associated pediatric vasculitis subtypes look similar to those in pediatric vasculitis not associated with COVID-19. Whether COVID-19 is the reason of the vasculitis or only the trigger remains unknown.
Keywords: COVID-19; Pathogenesis; Pediatric vasculitis; SARS-CoV-2.
【저자키워드】 COVID-19, Pathogenesis, SARS-CoV-2., Pediatric vasculitis, 【초록키워드】 Corticosteroid, Treatment, SARS-CoV-2, Arthritis, Coronavirus disease 2019, pediatric, children, Diagnosis, systematic review, MIS-C, immunosuppressive drugs, IgA, rheumatology, Patient, phenotype, Vasculitis, age, Central nervous system, skin, patients, clinical feature, Evidence, Analysis, Inflammatory, manifestation, chilblain, criteria, Cyclophosphamide, Remission, median age, syndrome, Final, article, renal, subtype, English, caused, died, the patient, was performed, majority, inflammatory complication, patients with COVID-19, secure, were excluded, with COVID-19, 【제목키워드】 pediatric, systematic review, Analysis,