Manifestaciones Autoinmunes en pacientes con COVID-19
Contenido principal del artículo
Barra lateral del artículo
Publicado
2021 diciembre 15
Dora Montiel Jarolin
Auda Quintana
Magalí Jarolin
César Riveros
Elvis Ibáñez
Estela Torres
Marlene Caballero
Verónica Taboada
Pedro Nuñez
Leticia Ferreira
Zoilo Morel
https://orcid.org/0000-0003-1587-7836
Auda Quintana
Magalí Jarolin
César Riveros
Elvis Ibáñez
Estela Torres
Marlene Caballero
Verónica Taboada
Pedro Nuñez
Leticia Ferreira
Zoilo Morel
Resumen
Introducción: Se han reportado varias manifestaciones autoinmunes en pacientes con COVID -19 agudo o posterior al mismo. El objetivo de este trabajo fue presentar una serie de casos de pacientes con COVID-19 y manifestaciones autoinmunes y autoinflamatorias.
Método: Serie de casos de pacientes adultos con COVID-19 agudo o antecedente del mismo, y manifestaciones autoinmunes y autoinflamatorias, internados en el Hospital Nacional de Paraguay, durante el periodo comprendido entre septiembre 2020 y agosto 2021.
Resultados: Se presentan diez pacientes con COVID-19 o antecedente cercano del mismo, y manifestaciones autoinmunes, con un promedio de 20 días después de iniciados los síntomas de COVID-19 (rango: 8-30 días). El 40% de los pacientes tenían patologías de base, como hipertensión arterial, obesidad, insuficiencia renal, diabetes, tabaquismo, y uso de drogas ilícitas como cocaína. Ningún paciente tenía antecedentes de enfermedad reumática. La complicación autoinmune más frecuente fue Síndrome de Guillain-Barré (SGB) (40%), seguida por vasculitis. La PCR del SARS-CoV-2 en hisopo nasofaríngeo y orofaríngeo fue positiva en el 80% de los casos, con presencia de Anticuerpos para Sars-Cov-2 en 4 casos. Se encontraron datos de citopenias (anemia severa y plaquetopenia) en aquellos pacientes con lupus eritematoso sistémico (LES), púrpura trombocitopénica trombótica (PTT) y púpura trombocitopenica inmune (PTI). En cuanto a la presencia de anticuerpos, solo fueron positivos: ANA en el paciente con LES y ANCA-c en el paciente con Granulomatosis con Poliangeitis. Tras el tratamiento inmunosupresor con corticoides sistémicos, IGIV, o incluso ciclofosfamida y Micofenolato mofetil según el caso, hubo mejoría clínica, excepto en dos pacientes que fallecieron.
Conclusión: El SGB, las manifestaciones autoinmunes hematológicas y las vasculitis fueron las manifestaciones más frecuentes, en relación a la infección por Sars-Cov 2. La mayoría de los pacientes presentó una buena evolución con el tratamiento inmunosupresor.
Cómo citar
1.
Montiel Jarolin D, Quintana A, Jarolin M, Riveros C, Ibáñez E, Torres E, et al. Manifestaciones Autoinmunes en pacientes con COVID-19. Rev. parag. reumatol. [Internet]. 2021 Dec. 15 [cited 2026 Oct. 5];7(2):34-40. Available from: https://revista.spr.org.py/index.php/spr/article/view/138
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Detalles del artículo
Keywords
manifestaciones autoinmunes, autoinflamatorias, COVID-19, SARS-COV-2
References
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(20) Lopez C, Kim J, Pandey A, Huang T, DeLoughery TG. Simultaneous onset of COVID-19 and autoimmune haemolytic anaemia. Br J Haematol. 2020 Jul;190(1):31-32. doi: 10.1111/bjh.16786.
(21) Jawed M, Hart E, Saeed M. Haemolytic anaemia: a consequence of COVID-19. BMJ Case Rep. 2020 Dec 10;13(12):e238118. doi: 10.1136/bcr-2020-238118.
(22) Mantovani Cardoso E, Hundal J, Feterman D, Magaldi J. Conco- mitant new diagnosis of systemic lupus erythematosus and COVID-19 with possible antiphospholipid syndrome. Just a coin- cidence? A case report and review of intertwining pathophysiology. Clin Rheumatol. 2020 Sep;39(9):2811-2815. doi: 10.1007/s10067- 020-05310-1.
(23) Gracia-Ramos AE, Saavedra-Salinas MÁ. Can the SARS-CoV-2 infection trigger systemic lupus erythematosus? A case-based review. Rheumatol Int. 2021 Apr;41(4):799-809. doi: 10.1007/ s00296-021-04794-7.
(24) Hali F, Jabri H, Chiheb S, Hafiani Y, Nsiri A. A concomitant diagnosis of COVID-19 infection and systemic lupus erythematosus compli- cated by a macrophage activation syndrome: A new case report. Int J Dermatol. 2021 Aug;60(8):1030-1031. doi: 10.1111/ijd.15592.
(25) Zulfiqar AA, Lorenzo-Villalba N, Hassler P, Andrès E. Immune Thrombocytopenic Purpura in a Patient with Covid-19. N Engl J Med. 2020 Apr 30;382(18):e43. doi: 10.1056/NEJMc2010472.
(26) Lévesque V, Millaire É, Corsilli D, Rioux-Massé B, Carrier FM. Severeimmune thrombocytopenic purpura in critical COVID-19. Int J Hematol.2020Nov;112(5):746750.doi: 10.1007/s12185-020- 02931-9.
(27) Bomhof G, Mutsaers PGNJ, Leebeek FWG, Te Boekhorst PAW, Hofland J, Croles FN, Jansen AJG. COVID-19-associated immune thrombocytopenia. Br J Haematol. 2020 Jul;190(2):e61-e64. doi: 10.1111/bjh.16850.
(28) Mahévas M, Moulis G, Andres E, Riviere E, Garzaro M, Crickx E, et al. Clinical characteristics, management and outcome of COVID-19-associated immune thrombocytopenia: a French multi- centre series. Br J Haematol. 2020 Aug;190(4):e224-e229. doi: 10.1111/bjh.17024.
(29) Lopes da Silva R. Viral-associated thrombotic microangiopathies. Hematol Oncol Stem Cell Ther. 2011:4(2):51-9. Doi: 10.5144/1658- 3876.2011.51
(30) Albiol N, Awol R, Martino R. Autoimmune thrombotic thrombo- cytopenic purpura (TTP) associated with COVID-19. Ann Hematol 2020;99(7):1673-1674. doi: 10.1007/s00277-020-04097-0.
(31) AL-Ansari RY, Bakkar M, Abdalla L, Sewify K. Critical Care COVID-19 Patient with a Picture of Thrombotic Thrombocytopenic Purpura. Eur J Case Rep Intern Med. 2020 Dec 15;7(12):002143. doi: 10.12890/2020_002143
(32) Altowyan E, Alnujeidi O, Alhujilan A, Alkathlan M. COVID-19 pre- senting as thrombotic thrombocytopenic purpura (TTP). BMJ Case Rep. 2020 Dec 17;13(12):e238026. doi: 10.1136/bcr-2020-238026.
(33) Beaulieu MC, Mettelus DS, Rioux- Massé B, Mahone M. Thrombotic thrombocytopenic purpura as the initial presentation of COVID- 19. J Thromb Haemost. 2021 Apr;19(4):1132-1134. doi: 10.1111/ jth.15231.
(34) Meppiel E, Peiffer-Smadja N, Maury A, Delorme C, Landré S, Petitgars P, et al. Manifestations neurologiques associées à l’infection SARS-CoV-2 : le registre français NeuroCOVID. Med Mal Infect. 2020 Sep;50(6):S20–1. French. doi: 10.1016/j.medmal.2020.06.047.
(35) Maury A, Lyoubi A, Peiffer-Smadja N, de Broucker T, Meppiel E. Neurological manifestations associated with SARS-CoV-2 and other coronaviruses: A narrative review for clinicians. Rev Neurol (Paris). 2021 Jan-Feb;177(1-2):51-64. doi: 10.1016/j.neurol.2020.10.001.
(36) Toscano G, Palmerini F, Ravaglia S, Ruiz L, Invernizzi P, Cuzzoni MG, et al. Guillain-Barré Syndrome Associated with SARS- CoV-2. N Engl J Med. 2020 Jun 25;382(26):2574-2576. doi: 10.1056/ NEJMc2009191.29.
(37) Abu-Rumeileh S, Abdelhak A, Foschi M, Tumani H, Otto M. Guillain- Barré syndrome spectrum associated with COVID-19: an up-to-date systematic review of 73 cases. J Neurol. 2021 Apr;268(4):1133- 1170. doi: 10.1007/s00415-020-10124-x.
(38) Fragiel M, Miró Ò, Llorens P, Jiménez S, Piñera P, Burillo G, et al. In- cidence, clinical, risk factors and outcomes of Guillain-Barré in Covid-19. Ann Neurol. 2021 Mar;89(3):598-603. doi: 10.1002/ ana.25987.34.
(39) Trujillo Gittermann LM, Valenzuela Feris SN, von Oetinger Giacoman A. Relation between COVID-19 and Guillain-Barré syndrome in adults. Systematic review. Neurologia (Engl Ed). 2020 Nov- Dec;35(9):646-654. English, Spanish. doi: 10.1016/j.nrl.2020.07.004.
(40) Sriwastava S, Kataria S, Tandon M, Patel J, Patel R, Jowkar Aet al. Guillain Barré Syndrome and its variants as a manifestation of COVID-19: A systematic review of case reports and case series. J Neurol Sci. 2021 Jan 15;420:117263. doi: 10.1016/j.jns. 2020.117263.
(2) Hu B, Guo H, Zhou P, Shi ZL. Characteristics of SARS-CoV-2 and COVID-19. Nat Rev Microbiol. 2021 Mar;19(3):141-154.
(3) Organización Mundial de la Salud (OMS). Alocución de apertura del Director General de la OMS en la rueda de prensa sobre la COVID-19 celebrada el 11 de marzo de 2020. https://www.who.int/ es/director-general/speeches/detail/who-director-general-s- opening-remarks-at-the-media-briefing-on-covid-19---11- march-2020
(4) Liu Y, Sawalha AH, Lu Q. COVID-19 and autoimmune diseases. Curr Opin Rheumatol. 2021 Mar 1;33(2):155-162. doi: 10.1097/ BOR.0000000000000776.
(5) Ehrenfeld M, Tincani A, Andreoli L, Cattalini M, Greenbaum A, Kanduc D, et al. Covid-19 and autoimmunity. Autoimmun Rev. 2020 Aug;19(8):102597. doi: 10.1016/j.autrev.2020.102597.
(6) Rodríguez Y, Novelli L, Rojas M, De Santis M, Acosta-Ampudia Y, Monsalve DM, et al. Autoinflammatory and autoimmune conditions at the crossroad of COVID-19. J Autoimmun. 2020 Nov;114:102506. doi: 10.1016/j.jaut.2020.102506.
(7) Galeotti C, Bayry J. Autoimmune and inflammatory diseases following COVID-19. Nat Rev Rheumatol. 2020 Aug;16(8):413-414. doi: 10.1038/s41584-020-0448-7.
(8) Gottlieb M, Long B. Dermatologic manifestations and complications of COVID-19. Am J Emerg Med. 2020 Sep;38(9):1715-1721. doi: 10.1016/j.ajem.2020.06.011.
(9) Kösters K, Schwarzer S, Labuhn A, Rübben A, Yang S, Hessler F, et al. Cutaneous Vasculitis in a Patient With COVID-19. Open Forum Infect Dis. 2020 Oct 5;7(10):ofaa474. doi: 10.1093/ofid/ofaa474.
(10) Becker RC. COVID-19-associated vasculitis and vasculopathy. J Thromb Thrombolysis. 2020 Oct;50(3):499-511. doi: 10.1007/ s11239-020-02230-4.
(11) Calabretta E, Moraleda JM, Iacobelli M, Jara R, Vlodavsky I, O‘Gorman P, et al. COVID-19-induced endotheliitis: emerging evidence and possible therapeutic strategies. Br J Haematol. 2021 Apr;193(1):43-51. doi: 10.1111/bjh.17240.
(12) Mayor-Ibarguren A, Feito-Rodriguez M, Quintana Castanedo L, Ruiz-Bravo E, Montero Vega D, Herranz-Pinto P. Cutaneous small vessel vasculitis secondary to COVID-19 infection: a case report. J Eur Acad Dermatol Venereol. 2020 Oct;34(10):e541-e542. doi: 10.1111/jdv.16670.
(13) Camprodon Gómez M, González-Cruz C, Ferrer B, Barberá MJ. Leucocytoclastic vasculitis in a patient with COVID-19 with positive SARS-CoV-2 PCR in skin biopsy. BMJ Case Rep. 2020 Oct 29;13(10):e238039. doi: 10.1136/bcr-2020-238039.
(14) Uppal NN, Kello N, Shah HH, Khanin Y, De Oleo IR, Epstein E, et al. De Novo ANCA-Associated Vasculitis With Glomerulonephritis in COVID-19. Kidney Int Rep. 2020 Nov;5(11):2079-2083. doi: 10.1016/ j.ekir.2020.08.012.
(15) Moeinzadeh F, Dezfouli M, Naimi A, Shahidi S, Moradi H. Newly Diagnosed Glomerulonephritis During COVID-19 Infection Under- going Immunosuppression Therapy, a Case Report. Iran J Kidney Dis. 2020 May;14(3):239-242.
(16) Powell WT, Campbell JA, Ross F, Peña Jiménez P, Rudzinski ER, Dickerson JA. Acute ANCA Vasculitis and Asymptomatic COVID-19. Pediatrics. 2021 Apr;147(4):e2020033092. doi: 10.1542/peds.2020- 033092.
(17) Capes A, Bailly S, Hantson P, Gerard L, Laterre PF. COVID-19 infection associated with autoimmune hemolytic anemia. Ann Hematol. 2020 Jul;99(7):1679-1680. doi: 10.1007/s00277-020- 04137-9.
(18) Lazarian G, Quinquenel A, Bellal M, Siavellis J, Jacquy C, Re D, et al. Autoimmune haemolytic anaemia associated with COVID-19 infection. Br J Haematol. 2020 Jul;190(1):29-31. doi: 10.1111 bjh.16794.
(19) Jacobs J, Eichbaum Q. COVID-19 associated with severe auto- immune hemolytic anemia. Transfusion. 2021 Feb;61(2):635-640. doi: 10.1111/trf.16226.
(20) Lopez C, Kim J, Pandey A, Huang T, DeLoughery TG. Simultaneous onset of COVID-19 and autoimmune haemolytic anaemia. Br J Haematol. 2020 Jul;190(1):31-32. doi: 10.1111/bjh.16786.
(21) Jawed M, Hart E, Saeed M. Haemolytic anaemia: a consequence of COVID-19. BMJ Case Rep. 2020 Dec 10;13(12):e238118. doi: 10.1136/bcr-2020-238118.
(22) Mantovani Cardoso E, Hundal J, Feterman D, Magaldi J. Conco- mitant new diagnosis of systemic lupus erythematosus and COVID-19 with possible antiphospholipid syndrome. Just a coin- cidence? A case report and review of intertwining pathophysiology. Clin Rheumatol. 2020 Sep;39(9):2811-2815. doi: 10.1007/s10067- 020-05310-1.
(23) Gracia-Ramos AE, Saavedra-Salinas MÁ. Can the SARS-CoV-2 infection trigger systemic lupus erythematosus? A case-based review. Rheumatol Int. 2021 Apr;41(4):799-809. doi: 10.1007/ s00296-021-04794-7.
(24) Hali F, Jabri H, Chiheb S, Hafiani Y, Nsiri A. A concomitant diagnosis of COVID-19 infection and systemic lupus erythematosus compli- cated by a macrophage activation syndrome: A new case report. Int J Dermatol. 2021 Aug;60(8):1030-1031. doi: 10.1111/ijd.15592.
(25) Zulfiqar AA, Lorenzo-Villalba N, Hassler P, Andrès E. Immune Thrombocytopenic Purpura in a Patient with Covid-19. N Engl J Med. 2020 Apr 30;382(18):e43. doi: 10.1056/NEJMc2010472.
(26) Lévesque V, Millaire É, Corsilli D, Rioux-Massé B, Carrier FM. Severeimmune thrombocytopenic purpura in critical COVID-19. Int J Hematol.2020Nov;112(5):746750.doi: 10.1007/s12185-020- 02931-9.
(27) Bomhof G, Mutsaers PGNJ, Leebeek FWG, Te Boekhorst PAW, Hofland J, Croles FN, Jansen AJG. COVID-19-associated immune thrombocytopenia. Br J Haematol. 2020 Jul;190(2):e61-e64. doi: 10.1111/bjh.16850.
(28) Mahévas M, Moulis G, Andres E, Riviere E, Garzaro M, Crickx E, et al. Clinical characteristics, management and outcome of COVID-19-associated immune thrombocytopenia: a French multi- centre series. Br J Haematol. 2020 Aug;190(4):e224-e229. doi: 10.1111/bjh.17024.
(29) Lopes da Silva R. Viral-associated thrombotic microangiopathies. Hematol Oncol Stem Cell Ther. 2011:4(2):51-9. Doi: 10.5144/1658- 3876.2011.51
(30) Albiol N, Awol R, Martino R. Autoimmune thrombotic thrombo- cytopenic purpura (TTP) associated with COVID-19. Ann Hematol 2020;99(7):1673-1674. doi: 10.1007/s00277-020-04097-0.
(31) AL-Ansari RY, Bakkar M, Abdalla L, Sewify K. Critical Care COVID-19 Patient with a Picture of Thrombotic Thrombocytopenic Purpura. Eur J Case Rep Intern Med. 2020 Dec 15;7(12):002143. doi: 10.12890/2020_002143
(32) Altowyan E, Alnujeidi O, Alhujilan A, Alkathlan M. COVID-19 pre- senting as thrombotic thrombocytopenic purpura (TTP). BMJ Case Rep. 2020 Dec 17;13(12):e238026. doi: 10.1136/bcr-2020-238026.
(33) Beaulieu MC, Mettelus DS, Rioux- Massé B, Mahone M. Thrombotic thrombocytopenic purpura as the initial presentation of COVID- 19. J Thromb Haemost. 2021 Apr;19(4):1132-1134. doi: 10.1111/ jth.15231.
(34) Meppiel E, Peiffer-Smadja N, Maury A, Delorme C, Landré S, Petitgars P, et al. Manifestations neurologiques associées à l’infection SARS-CoV-2 : le registre français NeuroCOVID. Med Mal Infect. 2020 Sep;50(6):S20–1. French. doi: 10.1016/j.medmal.2020.06.047.
(35) Maury A, Lyoubi A, Peiffer-Smadja N, de Broucker T, Meppiel E. Neurological manifestations associated with SARS-CoV-2 and other coronaviruses: A narrative review for clinicians. Rev Neurol (Paris). 2021 Jan-Feb;177(1-2):51-64. doi: 10.1016/j.neurol.2020.10.001.
(36) Toscano G, Palmerini F, Ravaglia S, Ruiz L, Invernizzi P, Cuzzoni MG, et al. Guillain-Barré Syndrome Associated with SARS- CoV-2. N Engl J Med. 2020 Jun 25;382(26):2574-2576. doi: 10.1056/ NEJMc2009191.29.
(37) Abu-Rumeileh S, Abdelhak A, Foschi M, Tumani H, Otto M. Guillain- Barré syndrome spectrum associated with COVID-19: an up-to-date systematic review of 73 cases. J Neurol. 2021 Apr;268(4):1133- 1170. doi: 10.1007/s00415-020-10124-x.
(38) Fragiel M, Miró Ò, Llorens P, Jiménez S, Piñera P, Burillo G, et al. In- cidence, clinical, risk factors and outcomes of Guillain-Barré in Covid-19. Ann Neurol. 2021 Mar;89(3):598-603. doi: 10.1002/ ana.25987.34.
(39) Trujillo Gittermann LM, Valenzuela Feris SN, von Oetinger Giacoman A. Relation between COVID-19 and Guillain-Barré syndrome in adults. Systematic review. Neurologia (Engl Ed). 2020 Nov- Dec;35(9):646-654. English, Spanish. doi: 10.1016/j.nrl.2020.07.004.
(40) Sriwastava S, Kataria S, Tandon M, Patel J, Patel R, Jowkar Aet al. Guillain Barré Syndrome and its variants as a manifestation of COVID-19: A systematic review of case reports and case series. J Neurol Sci. 2021 Jan 15;420:117263. doi: 10.1016/j.jns. 2020.117263.
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Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
Cómo citar
1.
Montiel Jarolin D, Quintana A, Jarolin M, Riveros C, Ibáñez E, Torres E, et al. Manifestaciones Autoinmunes en pacientes con COVID-19. Rev. parag. reumatol. [Internet]. 2021 Dec. 15 [cited 2026 Oct. 5];7(2):34-40. Available from: https://revista.spr.org.py/index.php/spr/article/view/138
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