The Characteristics of Patients With COVID-19-Associated Pediatric Vasculitis: An International, Multicenter Study

Scientific paper - Original scientific paper

• Author: Ezgi D. Batu
• Author: Seher Sener
• Author: Gulcan Ozomay Baykal
• Author: Elif Arslanoglu Aydin
• Author: Semanur Özdel
• Author: Alenka Gagro
• Author: Esra Esen
• Author: Merav Heshin‐Bekenstein
• Author: Nilüfer Akpınar Tekgöz
• Author: Fatma G. Demirkan
• Author: Kubra Ozturk
• Author: Olga Vougiouka
• Author: H. Emine Sonmez
• Author: Maria Cristina Maggio
• Author: Ummusen Kaya Akca
• Author: Marija Jelušić
• Author: Aysenur Pac Kısaarslan
• Author: Banu Acar
• Author: Nuray Aktay Ayaz
• Author: Betül Sözeri
• Author: Seza Özen
• Author's institution: University of Zagreb; School of Medicine; (Department of Pediatrics)
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Pediatrics

Abstract (english)

Objective: COVID-19-associated pediatric vasculitis, other than Kawasaki disease (KD)-like vasculitis in multisystem inflammatory syndrome in children (MIS-C), is very rare. This study sought to analyze the characteristics, treatment, and outcomes in patients with COVID-19-associated pediatric vasculitis (excluding KD-like vasculitis in MIS-C).

Methods: The inclusion criteria were as follows: 1) age <18 years at vasculitis onset; 2) evidence of vasculitis; 3) evidence of SARS-CoV-2 exposure; and 4) ≤3 months between SARS-CoV-2 exposure and vasculitis onset. Patients with MIS-C were excluded. The features of the subset of patients in our cohort who had COVID-19-associated pediatric IgA vasculitis/Henoch Schönlein purpura (IgAV/HSP) were compared against a pre-pandemic cohort of pediatric IgAV/HSP patients.

Results: Forty-one patients (median age 8.3 years; male to female ratio 1.3) were included from 14 centers and 6 countries. The most frequent vasculitis subtype was IgAV/HSP (n = 30). The median duration between SARS-CoV-2 exposure and vasculitis onset was 13 days. Involvement of the skin (92.7%) and of the gastrointestinal system (61%) were the most common manifestations of vasculitis. Most patients (68.3%) received glucocorticoids, and 14.6% also received additional immunosuppressive drugs. Remission was achieved in all patients. All of the patients with IgAV/HSP in our cohort had skin manifestations, while 18 (60%) had gastrointestinal involvement and 13 (43.3%) had renal involvement. When we compared the features of this subset of 30 patients to those of a pre-pandemic pediatric IgAV/HSP cohort (n = 159), the clinical characteristics of fever and renal involvement were more common in our COVID-19-associated pediatric IgAV/HSP cohort (fever, 30% versus 5%, respectively [P < 0.001]; renal involvement, 43.3% versus 17.6%, respectively [P = 0.002]). Recovery without treatment and complete recovery were each less frequent among our COVID-19-associated pediatric IgAV/HSP patients compared to the pre-pandemic pediatric IgAV/HSP cohort (recovery without treatment, 10% versus 39%, respectively [P = 0.002]; complete recovery, 86.7% versus 99.4%, respectively [P = 0.002]).

Conclusion: This is the largest cohort of children with COVID-19-associated vasculitis (excluding MIS-C) studied to date. Our findings suggest that children with COVID-19-associated IgAV/HSP experience a more severe disease course compared to pediatric IgAV/HSP patients before the pandemic.

• Keywords (english): Adolescent; COVID-19* / complications; Child; Female; Humans; IgA Vasculitis* / complications; IgA Vasculitis* / drug therapy; IgA Vasculitis* / epidemiology; Immunoglobulin A; Male; Mucocutaneous Lymph Node Syndrome* / complications; SARS-CoV-2; Vasculitis* / epidemiology; Vasculitis* / etiology
• Language: english
• Publication type: Scientific paper - Original scientific paper
• Publication status: Published
• Peer review: Peer review
• Publication version: Published version
• Journal title: Arthritis & Rheumatology
• Numbering: vol. 75, no. 4, pp. 499-506
• p-ISSN: 2326-5191
• e-ISSN: 2326-5205
• DOI: https://doi.org/10.1002/art.42411
• URN:NBN: urn:nbn:hr:105:574742
• Publication: 2023-04
• Document URL: https://onlinelibrary.wiley.com/doi/10.1002/art.42411
• Type of resource: Text
• Access conditions: Open access
• Created on: 2023-07-11 11:24:14