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Acute ANCA Vasculitis and Asymptomatic COVID-19 Weston T. Powell MD, PhD; Julie A. Campbell, MD; Francesca Ross, MD,
Patricia Peña Jiménez, MD, Erin R. Rudzinski, MD, Jane A. Dickerson, PhD
DOI: 10.1542/peds.2020-033092
Journal: Pediatrics
Article Type: Case Report
Citation: Powell WT, Campbell JA, Ross F, Peña Jiménez P, Rudzinski ER, Dickerson JA. Acute ANCA vasculitis and asymptomatic COVID-19. Pediatrics. 2021; doi: 10.1542/peds.2020-033092
This is a prepublication version of an article that has undergone peer review and been accepted for publication but is not the final version of record. This paper may be cited using the DOI and date of access. This paper may contain information that has errors in facts, figures, and statements, and will be corrected in the final published version. The journal is providing an early version of this article to expedite access to this information. The American Academy of Pediatrics, the editors, and authors are not responsible for inaccurate information and data described in this version.
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Weston T. Powell MD, PhD1,* Julie A. Campbell, MD2,* Francesca Ross, MD,3
Patricia Peña Jiménez, MD,4 Erin R. Rudzinski, MD,5 Jane A. Dickerson, PhD,5
* Contributed equally as co-first authors
Affiliations: 1Division of Pediatric Pulmonary and Sleep Medicine, Seattle Children’s Hospital, University of Washington, Seattle, WA. 2Division of Pediatric Rheumatology, Seattle Children’s Hospital, University of Washington, Seattle, WA 3Seattle Children’s Hospital, University of Washington, Seattle, WA 4Division of Pediatric Critical Care Medicine, Seattle Children’s Hospital, University of Washington, Seattle, WA 5Department of Laboratories, Seattle Children’s Hospital, University of Washington, Seattle, WA Corresponding author: Weston T. Powell, MD, PhD, M/S OC.7.720, Seattle Children’s Hospital, Seattle, WA, 98105. 206-987-5756. [email protected] Conflicts of Interest and Disclosures: The authors have no conflicts of interest relevant to this article to disclose. Abbreviations: MIS-C: multisystem inflammatory syndrome in children SARS-CoV-2: severe acute respiratory syndrome coronavirus 2 WBC: white blood cell count CRP: c-reactive protein ESR: erythrocyte sedimentation rate Anti-MPO: myeloperoxidase antibody ANCA: Antineutrophil cytoplasmic antibodies BAL: bronchoalveolar lavage Article Summary: We describe the case of a child with asymptomatic COVID-19 infection and newly diagnosed ANCA-vasculitis leading to pulmonary hemorrhage.
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Contributors’ Statement Dr. Weston T. Powell and Dr. Julie Campbell collected clinical history and data, drafted the initial manuscript, and reviewed and revised the manuscript. Dr. Francesca Ross and Dr. Patricia Peña Jimenez collected clinical history and data, and reviewed and revised the manuscript. Dr. Erin Rudzinski performed pathologic analysis, reviewed clinical history and data, and reviewed and revised the manuscript. Dr. Jane Dickerson performed clinical laboratory testing, reviewed clinical history and data, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
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We describe the presentation and diagnosis of a child with newly diagnosed ANCA-associated vasculitis and associated diffuse alveolar hemorrhage who was positive for COVID-19 IgG antibodies indicative of a prior asymptomatic infection. Multiple PCR-based tests coinciding with the start of symptoms were negative indicating that acute infection was not the cause of the patient’s symptoms. COVID-19 induced autoimmune diseases have been described in adults, but this represents the first case described in a pediatric patient.
Introduction
The global pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-
CoV-2) has led to rapid recognition of the acute disease COVID-19 and sequelae of the acute
infection.1 The symptoms of COVID-19 are varied, particularly in children who more frequently
have asymptomatic or minimally symptomatic disease or the newly described multisystem
inflammatory syndrome in children (MIS-C).2 The spectrum of disease and potential sequelae
from acute infection, particularly in children, is not fully described. We report a case of an
adolescent who presented with an ANCA-associated vasculitis causing diffuse alveolar
hemorrhage following asymptomatic COVID-19 infection.
Case
A 12-year-old female with progressive respiratory failure was transferred to a tertiary children’s
hospital from a community hospital for further diagnostic evaluation and management. Two
weeks prior to transfer, she had onset of mild, productive cough with blood streaked sputum
without any respiratory distress, fevers, rash, bruising, or joint pain. On physical exam by her
primary care physician, she had crackles at the left lung base. Community acquired pneumonia
was diagnosed and amoxicillin prescribed. Due to high prevalence of COVID-19 in the
community (25-30% positive community testing rate in the week of illness onset),
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should be further tested. To the best of our knowledge, this represents the first case of an
asymptomatic infection with the subsequent diagnosis of an ANCA vasculitis in a child. This
case highlights the need for careful monitoring of long-term sequelae of COVID-19 in children
given their frequent asymptomatic or minimally symptomatic infections.
References
1. Dong Y, Mo X, Hu Y, et al. Epidemiology of COVID-19 Among Children in China. Pediatrics. 2020;145(6). doi:10.1542/peds.2020-0702
2. Abrams JY, Godfred-Cato SE, Oster ME, et al. Multisystem Inflammatory Syndrome in Children Associated with Severe Acute Respiratory Syndrome Coronavirus 2: A Systematic Review. The Journal of Pediatrics. 2020;226:45-54.e1. doi:10.1016/j.jpeds.2020.08.003
3. Bryan A, Pepper G, Wener MH, et al. Performance Characteristics of the Abbott Architect SARS-CoV-2 IgG Assay and Seroprevalence in Boise, Idaho. J Clin Microbiol. 2020;58(8). doi:10.1128/JCM.00941-20
4. Tzouvelekis A, Karampitsakos T, Krompa A, Markozannes E, Bouros D. False Positive COVID-19 Antibody Test in a Case of Granulomatosis With Polyangiitis. Front Med (Lausanne). 2020;7:399. doi:10.3389/fmed.2020.00399
5. Deeks JJ, Dinnes J, Takwoingi Y, et al. Antibody tests for identification of current and past infection with SARS-CoV-2. Cochrane Database Syst Rev. 2020;6:CD013652. doi:10.1002/14651858.CD013652
6. Bahar B, Jacquot C, Mo YD, DeBiasi RL, Campos J, Delaney M. Kinetics of Viral Clearance and Antibody Production Across Age Groups in Children with Severe Acute Respiratory Syndrome Coronavirus 2 Infection. J Pediatr. 2020;227:31-37.e1. doi:10.1016/j.jpeds.2020.08.078
7. Giollo A, Bixio R, Gatti D, et al. Challenge of diagnosing ANCA-associated vasculitis during COVID-19 pandemic: a missed ‘window of opportunity.’ Annals of the Rheumatic Diseases. Published online August 19, 2020. doi:10.1136/annrheumdis-2020-218830
8. Löffler C, Mahrhold J, Fogarassy P, Beyer M, Hellmich B. Two Immunocompromised Patients With Diffuse Alveolar Hemorrhage as a Complication of Severe Coronavirus Disease 2019. Chest. 2020;158(5):e215-e219. doi:10.1016/j.chest.2020.06.051
9. von Ranke FM, Zanetti G, Hochhegger B, Marchiori E. Infectious diseases causing diffuse alveolar hemorrhage in immunocompetent patients: a state-of-the-art review. Lung. 2013;191(1):9-18. doi:10.1007/s00408-012-9431-7
by guest on August 11, 2021www.aappublications.org/newsDownloaded from
10. Uppal NN, Kello N, Shah HH, et al. De Novo ANCA-Associated Vasculitis With Glomerulonephritis in COVID-19. Kidney International Reports. 2020;5(11):2079-2083. doi:10.1016/j.ekir.2020.08.012
12. Dalakas MC. Guillain-Barré syndrome: The first documented COVID-19-triggered autoimmune neurologic disease: More to come with myositis in the offing. Neurol Neuroimmunol Neuroinflamm. 2020;7(5). doi:10.1212/NXI.0000000000000781
13. Guilmot A, Maldonado Slootjes S, Sellimi A, et al. Immune-mediated neurological syndromes in SARS-CoV-2-infected patients. J Neurol. Published online July 30, 2020. doi:10.1007/s00415-020-10108-x
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Figure 1. Chest CT image demonstrating left lower lobe consolidation and patchy infiltrate in other lung fields.
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originally published online January 20, 2021; Pediatrics Rudzinski and Jane A. Dickerson
Weston T. Powell, Julie A. Campbell, Francesca Ross, Patricia Peña Jiménez, Erin R.Acute ANCA Vasculitis and Asymptomatic COVID-19
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