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SARS-CoV-2 infection triggering a giant cell arteritis
Infección por SARS-CoV-2 como desencadenante de una arteritis de células gigantes
Núria Riera-Martía,
Corresponding author
nriera@tauli.cat

Corresponding author.
, Jorge Romanía, Joan Calvetb
a Department of Dermatology, Parc Taulí Health Corporation Consortium of Sabadell, Barcelona, Spain
b Department of Rheumatology, Parc Taulí Health Corporation Consortium of Sabadell, Barcelona, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Different infectious agents have been suggested to be involved in the pathogenesis of both classical and self-limited Giant Cell Arteritis &#40;GCA&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">On 14th March 2020&#44; a 50-year-old-man without past medical history was assessed through teleconsultation with a dermatologist during the state of alarm due to Covid-19 in Spain&#46; He reported high fever&#44; cough and severe headache with bilateral temporal arteries thickening&#46; No diagnostic tests could be performed at that time&#46; As a non-severe SARS-CoV-2 infection was suspected&#44; and visual or osteomuscular alterations were not reported&#44; we opted for a late referral to specialized care and remote monitoring of the symptoms&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">One month later&#44; the patient presented not any more Covid-19 symptoms but reported persistent headache and temporomandibular joint pain&#46; Clinical examination revealed swelling and inflammation of his right temple&#44; where a filiform pulse was noted&#46; A notable improvement from the previous temporal thickening was observed&#46; At that time&#44; several diagnostic tests were performed&#46; Blood tests yielded normal or negative results&#44; including erythrocyte sedimentation rate &#40;ESR&#41;&#44; C-reactive protein &#40;CRP&#41; and autoimmunity profile&#59; Covid-19 IgM&#47;IgG Rapid Test &#40;VivaCheck Biotech &#40;Hangzhou&#41; Co&#46;&#44; Ltd&#46;&#41; was positive for both IgG and IgM&#59; and a Doppler ultrasound of the right temporal artery showed a dark halo around lumen with a marked flow impairment&#44; suggesting arterial wall inflammation&#44; while left temporal artery Doppler echography was normal&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Two weeks later&#44; an FDG PET-CT scan was performed&#44; showing a slight increase of metabolic activity in the abdominal aorta&#44; with a maximum standardized uptake value of 2&#46;3<span class="elsevierStyleHsp" style=""></span>g&#47;ml compared to 2&#46;2<span class="elsevierStyleHsp" style=""></span>g&#47;ml in the liver&#44; without current active vasculitis signs&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Follow-up at three weeks revealed spontaneous clinical improvement with no corticosteroid treatment needed and a new temporal artery Doppler ultrasound was performed showing a resolution of arterial wall inflammation and blood flow&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Taking into account the complementary tests and the clinical evolution&#44; we conclude that the most likely diagnosis was a Giant Cell Arteritis &#40;GCA&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Given the coincidence in time with the surrounding SARS-CoV-2 infection we hypothesize that the virus could have acted as a trigger&#44; because of its affinity for vascular endothelia&#46; Varicella Zoster Virus &#40;VZV&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleItalic">Chlamydia pneumoniae</span>&#44; Parvovirus B19 and Epstein Barr Virus&#44; have been suggested to trigger GCA&#46; Our patient presented atypical clinical features of CGA with spontaneous resolution&#44; which supports a virus-related pathogenesis&#46; In addition&#44; other vasculitis&#44; such as Kawasaki disease in children or neurological complication with CNS vasculitis-like pattern&#44; have been recently linked to Covid-19&#44;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3&#44;4</span></a> which supports our hypothesis&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Our main limitation is the lack of histological confirmation&#46; However&#44; the absence of any biologic abnormality in blood tests could be explained by the fact that biologic tests were performed after the patient presented with symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> At the same time&#44; we should take into account that general systemic symptoms&#44; evaluated by telephone triage or similar&#44; might be wrongly attributed to Covid-19&#44; leading to the delayed diagnosis of this rheumatologic condition&#44; which in turn could prompt to an irreversible visual loss&#44; highlighting the severity of indirect morbidity related to Covid-19&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">There is no funding to report for this submission&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Contributors</span><p id="par0045" class="elsevierStylePara elsevierViewall">All authors have made substantial contributions in each of the following aspects&#58; study conception and design&#44; analysis and interpretation of data&#44; draft manuscript&#44; critical review of its intellectual content and definitive approval of the final version&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Patient and public involvement</span><p id="par0050" class="elsevierStylePara elsevierViewall">This research was done without patient involvement&#46; Patients were not invited to comment on the study design and were not consulted to develop patient relevant outcomes or interpret the results&#46; Patients were not invited to contribute to the writing or editing of this document for readability or accuracy&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Competing interests</span><p id="par0055" class="elsevierStylePara elsevierViewall">No&#44; there are no competing interests for any author&#46;</p></span></span>"
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Article information
ISSN: 23870206
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos