New-onset systemic vasculitis following SARS-CoV-2 infection and vaccination: the trigger, phenotype, and outcome
Mv P. Auanassova A. Yessirkepov M. Zimba O. Gasparyan A.Y. Kitas G.D. Ahmed S.
October 2023Springer Science and Business Media Deutschland GmbH
Clinical Rheumatology
2023#42Issue 102761 - 2775 pp.
The global health crisis caused by the COVID-19 pandemic overwhelmed the capacity of healthcare systems to cope with the rapidly spreading infection and its associated complications. Among these complications, autoimmune phenomena such as systemic vasculitis emerged as a significant challenge. Both the SARS-CoV-2 virus and the vaccines developed to combat it appeared to induce clinical manifestations resembling various types of systemic vasculitis, affecting large, medium, and small vessels. These virus- or vaccine-induced vasculitides exhibited a distinct natural history and course from de novo vasculitis, as they were more responsive to steroid therapy and some mild cases even resolved spontaneously. Notably, there have been no confirmed cases of SARS-CoV-2 infection or vaccination triggering variable vessel vasculitis like Behcet’s disease or Kawasaki disease. IgA vasculitis, which is predominantly a pediatric condition, was more prevalent in adults after COVID-19 infection and they had a favorable outcome with glucocorticoid treatment. The impact of immunosuppression, especially B-cell-depleting agents, on the immunogenicity of the vaccine was evident, but there was no significant increase in the incidence of SARS-CoV-2 infection in these patients compared to the general population. Considering their relatively benign course, these post-COVID or post-vaccine vasculitides seem to be amenable to 0.8 to 1 mg/kg prednisolone or equivalent, which could be gradually tapered. The need for immunosuppression and the duration of steroid therapy should be determined on an individual basis. While the world still reels from the perils of a deadly pandemic, the aftermath continues to haunt. Our narrative review aims to explore the effects of COVID and the vaccine on systemic vasculitis, as well as the effect of disease and immunosuppression on the immunogenicity of the COVID vaccine.
COVID-19 , Rheumatic disease , Secondary vasculitis , Vaccination , Vasculitis
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Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, 751024, India
Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
Department of Clinical Rheumatology and Immunology, University Hospital in Krakow, Krakow, Poland
National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
Department of Internal Medicine N2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, West Midlands, Dudley, United Kingdom
Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
Department of Clinical Immunology and Rheumatology
Department of Biology and Biochemistry
Department of Clinical Rheumatology and Immunology
National Institute of Geriatrics
Department of Internal Medicine N2
Departments of Rheumatology and Research and Development
Centre for Epidemiology Versus Arthritis
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