COVID-19 aggravates limb ischemia in Systemic Scleroderma patients: A case report
Philippines: According to a case report published in BMC Pediatrics, COVID-19 aggravates limb ischemia in Systemic Scleroderma patients. The case report added knowledge on the interaction between COVID-19 and hyperinflammation in the case of rheumatologic disorder.
Juvenile Scleroderma is one of the rare autoimmune diseases of the connective tissue. The concurrence of this autoimmune disorder with COVID-19 can cause limb ischemia because both disease entities are pro-inflammatory and pro-thrombotic. There needs to be more data in this context, and there needs to be more case reports describing the symptomatology and disease course in juvenile Scleroderma and COVID-19 patients.
Addressing and investigating the above concern, a case study was presented by a team of researchers led by Mark Jason D. C. Milan and colleagues from the College of Medicine and Philippine General Hospital.
The case was presented as follows:
- An adolescent with acute limb ischemia presented and had generalized hypo-and-hyperpigmented skin lesions history.
- The patient also had a mild, non-productive cough.
- She tested positive for SARS-CoV-2 on a nasopharyngeal swab detected by RT-PCR.
- The tests revealed elevated anti-phospholipid antibodies, anti-nuclear antibodies, and D-dimer.
- Protein S activity was low.
- There was evidence of peripheral arterial disease in imaging studies.
- The patient started peripheral vasodilators, Methotrexate, and anticoagulation.
- The researchers monitored affected limbs and other organs closely.
- After regular infusion of Cyclophosphamide, limb ischemia was controlled after four months.
- The multi-disciplinary care was continued for the patient.
To conclude, there is the interplay of COVID-19 hyperinflammatory state, and rheumatologic disorders and this knowledge in this context is evolving.
COVID-19 exacerbates cutaneous manifestations of autoimmune disorders via antigen protein mimicry and cytokine imbalance. COVID-19 and systemic sclerosis exhibit elevated D-dimer, which owe to their pro-thrombotic sequela.
More data must be collected on the association of Protein S activity with COVID-19 and systemic sclerosis. However, more studies are warranted to arrive at a consensus on thrombosis prophylaxis for Scleroderma and COVID-19 patients.
Further reading:
Milan, MJDCMJDC, Dans, LFLF & Torres-Ticzon, V.M.F. Acute limb ischemia in an adolescent with COVID-19 and systemic scleroderma: a case report. B.M.C. Pediatr 22, 737 (2022). https://doi.org/10.1186/s12887-022-03761-w
Disclaimer: This website is primarily for healthcare professionals. The content here does not replace medical advice and should not be used as medical, diagnostic, endorsement, treatment, or prescription advice. Medical science evolves rapidly, and we strive to keep our information current. If you find any discrepancies, please contact us at corrections@medicaldialogues.in. Read our Correction Policy here. Nothing here should be used as a substitute for medical advice, diagnosis, or treatment. We do not endorse any healthcare advice that contradicts a physician's guidance. Use of this site is subject to our Terms of Use, Privacy Policy, and Advertisement Policy. For more details, read our Full Disclaimer here.
NOTE: Join us in combating medical misinformation. If you encounter a questionable health, medical, or medical education claim, email us at factcheck@medicaldialogues.in for evaluation.