Vasculitis: Post-COVID Immune Response and Concerns

Vasculitis issues

I was diagnosed with COVID-19 on June 11, and around June 24, I noticed purpura and petechiae on my calves.
On June 26, I visited a dermatologist who ordered blood tests including CBC, ESR, creatinine, AST, ALT, and CRP.
The urine test results were all normal.
Additionally, C3 was 91.9 (normal range 90-180), C4 was 25.2 (normal range 10-40), A-DSDNA was 26.5, and ANA was negative.
The doctor suggested that the symptoms might be due to an immune response post-diagnosis, leading to vasculitis, and prescribed oral steroids to be taken twice daily.
Later, due to ongoing nasal symptoms, I was concerned that my vasculitis might be associated with ANCA.
I independently had an ANCA test for anti-neutrophil cytoplasmic antibodies, which returned negative.
However, I still have questions because I understand that ANCA antibodies can be classified into c-ANCA and p-ANCA, but the testing facility only performed a single ANCA test.
Does a negative result mean that there is no issue and I should not worry, or should I pursue further testing for both types? Additionally, the purpura on my legs has gradually faded.
Should I be concerned about potential damage to my kidneys or other organs, or, as the doctor suggested, is it likely just a short-term immune reaction due to the COVID-19 diagnosis?

Guang, 40~49 year old female. Ask Date: 2023/06/30

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your inquiry.
The ANCA test performed at a general laboratory can initially determine the presence of ANCA, and there is usually no need to specifically test for c-ANCA and p-ANCA unless the ANCA result is positive, at which point differentiation is necessary.
Additionally, since your skin symptoms have been gradually improving, there is no need for concern.
This message is from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare, caring for you.

Reply Date: 2023/06/30

More Info

Understanding vasculitis, especially in the context of post-COVID immune responses, is crucial for managing potential complications that may arise after a COVID-19 infection. Your experience with the appearance of petechiae (small purple spots) on your lower leg following a COVID-19 diagnosis raises important questions about the underlying mechanisms at play and the implications for your health.

Firstly, it is well-documented that COVID-19 can trigger a hyper-inflammatory response in some individuals, leading to various complications, including vasculitis. This occurs when the immune system mistakenly attacks the body’s own blood vessels, resulting in inflammation and damage. The symptoms you are experiencing, such as the petechiae, can indeed be indicative of such an immune response. The fact that your healthcare provider has initiated treatment with corticosteroids suggests that they are taking a proactive approach to manage this inflammation and prevent further complications.

Regarding your laboratory results, the normal values for C3, C4, and the negative results for anti-dsDNA and ANA are reassuring. These tests are often used to assess for systemic lupus erythematosus (SLE) and other autoimmune conditions. The negative ANCA (anti-neutrophil cytoplasmic antibodies) test is also a positive sign, as it suggests that you may not have a specific type of vasculitis associated with ANCA positivity, such as granulomatosis with polyangiitis or microscopic polyangiitis.

Your concern about the need for further testing for c-ANCA and p-ANCA is valid. While a negative ANCA test is generally reassuring, the presence of symptoms and your history may warrant further investigation. If your healthcare provider believes that there is a possibility of ANCA-associated vasculitis, they may recommend additional testing. However, if your symptoms are improving and your doctor is confident in their assessment, it may not be necessary to pursue further ANCA testing at this time.

As for your concern about the potential for the vasculitis to affect your kidneys or other organs, it is important to monitor your symptoms closely. The fact that your petechiae are fading is a positive sign, indicating that the inflammatory response may be resolving. However, ongoing vigilance is essential. If you experience new symptoms, such as changes in urination, swelling, or other systemic symptoms, it is crucial to seek medical attention promptly.
In summary, while your current situation appears to be a post-COVID immune response leading to transient vasculitis, it is essential to maintain open communication with your healthcare provider. Regular follow-ups and monitoring of your symptoms will help ensure that any potential complications are addressed early. If you have any lingering concerns or if your symptoms change, do not hesitate to reach out to your healthcare provider for further evaluation and guidance.

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