Virus and Autoimmunity: Can SARS-CoV-2 Trigger Large Vessel Vasculitis?

Area of Science:

• Rheumatology
• Infectious Diseases
• Immunology

Background:

• Viral infections, including SARS-CoV-2, are increasingly linked to autoimmune diseases.
• Rheumatic conditions like vasculitis and arthritis have been observed following COVID-19.
• Large vessel vasculitis (LVV) is a less commonly reported post-viral autoimmune manifestation.

Purpose of the Study:

• To report a case of large vessel vasculitis (LVV) temporally associated with SARS-CoV-2 infection.
• To highlight the potential for SARS-CoV-2 to trigger autoimmune responses beyond typical rheumatic manifestations.
• To emphasize the importance of considering LVV in patients with post-viral inflammatory syndromes.

Main Methods:

• Case report of a 19-year-old woman with symptoms 5 weeks after mild COVID-19.
• Diagnostic work-up included serological tests, computed tomography (CT), and fluorodeoxyglucose positron emission tomography (FDG-PET).
• Treatment involved prednisolone, with subsequent normalization of symptoms and laboratory values.

Main Results:

• The patient presented with fatigue, malaise, chest, and low back pain, indicative of a proinflammatory state.
• Imaging revealed inflammatory changes in the aorta and proximal iliac and renal arteries, consistent with LVV.
• Prednisolone treatment led to symptom resolution and normalization of inflammatory markers.

Conclusions:

• Recent SARS-CoV-2 infection can precipitate large vessel vasculitis, such as Takayasu arteritis.
• Early recognition and differential diagnosis of LVV are crucial to exclude mimics.
• Physicians must be aware of the broad spectrum of autoimmune diseases potentially triggered by SARS-CoV-2 for timely intervention and improved outcomes.