1 - Departamento de Infeciologia Pediátrica, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa
2 - Departamento de Reumatologia Pediátrica, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa
- Apresentação sob a forma de poster numa reunião internacional – 39th Annual Meeting of the European Society of Paediatric Infectious Diseases (ESPID)
Resumo:
Introdução: The SARS-CoV-2 infection seems to cause a variable inflammatory response in different patients and there is some evidence that it can set off autoimmunity.
Relato do caso: An 11-year-old girl presented with a month-long history of wrists and fingers arthralgia and morning stiffness. Two weeks later, she developed dry cough and chest pain and was medicated with azithromycin, acetaminophen and ibuprofen. Due to persistent symptoms and appearance of low-grade fever for two days, she was admitted. She was febrile (38ºC), eupnoeic, with decreased right lower vesicular murmur, and wrists, 2nd and 3rd metacarpophalangeal and interphalangeal symmetric arthritis. Leukocytes were 4.500/µL, C-reactive protein 13,9 mg/L, sedimentation rate 46 mm/h, and sterile leukocyturia (74/µL), without proteinuria. Nasopharyngeal RT-PCR for SARS-CoV-2 was positive (Ct 32). The chest radiography showed a pleural effusion. Other infections were excluded. HLA-B27, Rheumatoid Factor and antibodies against SARS-CoV-2 were negative. She had ANA (1:640), anti-dsDNA antibody (385,3 UI/mL), anti-nucleosome (215,00 U/mL) and anti-histones positive; coombs was weak positive. The pleural fluid analysis was an exudate, without neoplastic cells and negative culture, pleural biopsy revealed non-specific inflammation. She was treated with amoxicillin clavulanate for eight days and non-steroidal anti-inflammatory drugs. According to EULAR 2019 criteria, she could be classified as systemic lupus erythematosus (SLE) for ANA positivity, joint involvement and pleural effusion. She started prednisone and hydroxychloroquine, with progressive clinical improvement, stopping steroids after five months, with no relapsing at 8-month follow-up, but maintaining ANA and anti-nucleosome antibodies at a lower titter.
Conclusão: We report an adolescent fulfilling SLE criterion in the context of a SARS-CoV-2 infection. Whether this represent a COVID induced or a primary Juvenile SLE time will tell.
Palavras Chave: Systemic lupus erythematosus (SLE), COVID-19, autoimmunity