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Objective: Hyperinflammation (HI) that develops in week 2 of COVID-19 contributes to a worse outcome. Because week 2 laboratory findings can be relatively mild, the available criteria for classification of hemophagocytic lymphohistiocytosis or macrophage activation syndrome are not helpful., Methods: Our study included a discovery cohort of patients from Turkey with symptomatic COVID-19 who were followed up while hospitalized during the initial wave and a replication cohort of hospitalized patients from a later period, all of whom required oxygen support and received glucocorticoids. Diagnosis of HI was made by an expert panel; most patients with COVID-19-associated HI (HIC) received tocilizumab or anakinra. Clinical and laboratory data from start day of treatment with tocilizumab or anakinra in HIC patients were compared with the data from day 5-6 in patients without HIC. Values maximizing the sensitivity and specificity of each parameter were calculated to determine criteria items., Results: The discovery cohort included 685 patients, and the replication cohort included 156 patients, with 150 and 61 patients receiving treatment for HI, respectively. Mortality rate in HI patients in the discovery cohort (23.3%) was higher than the rate in patients without HI (3.7%) and the rate in patients in the overall replication cohort (10.3%). The 12-item criteria that we developed for HIC showed that a score of 35 provided 85.3% sensitivity and 81.7% specificity for identification of HIC. In the replication cohort, the same criteria resulted in 90.0% sensitivity for HIC; however, lower specificity values were observed because of the inclusion of milder cases of HIC responding only to glucocorticoids., Conclusion: The use of the 12-item criteria for HIC can better define patients with HIC with reasonable sensitivity and specificity and enables an earlier treatment start., (© 2022 American College of Rheumatology.)

Introduction: COVID-19 pandemic created concerns among patients receiving immunosuppressive therapy. Frequency of COVID-19 and impact of lockdown on treatment compliance in patients with vasculitis are largely unknown., Patients and Method: Patients with ANCA-associated and large vessel vasculitis that have been followed-up in our clinic were contacted by phone and a questionnaire containing home isolation status, treatment adherence and history of COVID -19 between March 1st and June 30th, 2020 was applied., Results: The survey was applied to 103 patients (F/M: 59/44, mean age: 53.2±12.5). Thirty-three (32%) patients didn?t attend at least one appointment; 98(95.1%) noted that they spent 3 months in home isolation. Five patients (4.8%) received immunosuppressives irregularly and 3(2.9%) developed symptoms due to undertreatment. Four (3.9%) patients admitted to hospital with a suspicion of COVID-19, but none of them had positive PCR or suggestive findings by imaging. COVID-19 diagnosed in a patient with granulomatosis with polyangiitis during hospitalization for disease flare and she died despite treatment., Discussion: Frequency of COVID-19 was low in patients with vasculitis in our single center cohort. Although outpatient appointments were postponed in one-third of our patients, high compliance with treatment and isolation rules ensured patients with vasculitis overcome this period with minimal morbidity and mortality., Competing Interests: All authors declare no conflicts of interest., (This work is licensed under a Creative Commons Attribution 4.0 International License.)

Copyright of Journal of Istanbul Faculty of Medicine / İstanbul Tıp Fakültesi Dergisi is the property of Istanbul Tip Fakultesi Dergisi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background/aim: Remdesivir, which was first developed for the treatment of Ebola disease but failed to meet expectations, has become hope in the fight against the COVID-19 pandemic. This study aimed to evaluate risk factors for mortality and prognosis of adult moderate/severe COVID-19 patients treated with remdesivir, and safety and tolerability of 5 days of remdesivir treatment. Materials and methods: This multicenter prospective observational study was conducted in 14 centers in Turkey. Pregnancy or breastfeeding, multiorgan failure, or usage of vasopressors for septic shock, ALT > 5 x the upper limit of the normal range, or eGRF <30 mL/min or dialysis and receiving favipiravir were the exclusion criteria of the study. Results: Among 500 patients, 494 patients were included in the study. On admission, 392 (79.3%) patients had moderate and 102 (20.6%) patients had severe COVID-19. The 28-day mortality was 10.1%. The median of the scores of the seven-category ordinal scale assessed on days 0, 3, 5, 7 were 4 and 3 on day 14. When the survival status of the patients was evaluated according to the time between the remdesivir start date and the end date of the symptoms, no statistically significant difference was found between the medians of the groups (p = 0.404). In multivariable analysis, age (OR, 1.05; 95%CI, 1.02-1.08; p = 0.003), SpO2 level on admission (OR, 3.03; 95%CI, 1.35-6.81; p = 0.007), heart rate (OR, 2.48; 95%CI, 1.01-6.07; p = 0.047), follow-up site at the hospital (clinic/ICU) (OR, 26.4; 95%CI, 11.6-60.17; p < 0.001) were independently associated with increased mortality. Grade 3 adverse event (AE) was observed in 4 (0.8%) patients. None of the patients experienced grade 4 or 5 AEs. Conclusion: Remdesivir is a safe and well-tolerated drug and older age, low SpO2 level on admission, tachycardia, and ICU admission are independently associated with increased mortality among patients with moderate/severe COVID-19 receiving remdesivir treatment. [ABSTRACT FROM AUTHOR]

Giriş: Koronavirüs hastalığı-2019 (COVID-19) seyrinde bazı hastalarda farklı nedenlerle sistemik bir hiperenflamatuvar yanıt ve bu zeminde farklı organ tutulumları gelişebilmektedir. Özellikle kardiyovasküler sistemde akut miyokardit ve perikardit görülebilmekle beraber, rekürren perikardit (RP) olguları nadirdir. Bildirimizde COVID-19 ilişkili RP olguları sunulmuştur (Klinik özellikler Tablo 1'de özetlenmiştir). Olgu 1: Olgumuzda COVID-19 sonrasında gelişen göğüs ağrısı nedeniyle yapılan incelemede akut faz reaktan (AFR) yüksekliği ve perikard efüzyonu saptandı. Kolşisin ve NSAİİ tedavisi altında kısmen gerileyen şikayetlerden 6 hafta sonra yüksek ateş, göğüs ağrısı nedeniyle tekrarlayan başvurusunda perikard efüzyonunun sebat ettiği, AFR yanıtının arttığı görüldü. Perikardit etiyolojisine yönelik tetkiklerde özellik saptanmadı. Prednizolon tedavisi (20 mg/gün) başlanarak 6 ayda azaltılarak kesildi, 10 aylık izleminde perikardit atağı tekrarlamadı. Olgu 2: Olgumuzda ikinci doz BNT162b2 aşısından 3 hafta sonra perikard efüzyonu saptandı. Kolşisin altında izlenirken geçirdiği COVID-19 sonrasında gelişen tamponad bulguları nedeniyle perikard penceresi açıldı. Bilateral plevral efüzyonu da olan hastanın tedavisine metilprednizolon eklendi. Etiyolojiye yönelik tetkiklerinde anlamlı patoloji saptanmadı. Metilprednizolon azatılarak kesildikten 8 hafta sonra göğüs ağrısıyla başvuran hastanın efüzyonunun tekrarladığı görüldü. Rekürren plöritperikardit tanısıyla anakinra tedavisi başlanan hastanın 10 haftalık izleminde tam klinik yanıt alındı. Olgu 3: Ateş ve göğüs ağrısıyla başvuran hastada AFR yüksekliği, plevral ve perikardiyal efüzyon saptandı. Akciğer parankiminde COVID-19 sekel bulguları görülmekle beraber sorgusunda semptomatik hastalık bulgusu tarif etmedi. Serozit etiyolojisine yönelik tetkiklerde özellik saptanmadı. NSAİİ ve kolşisin altında plevral efüzyonun progrese olduğu görüldü, tedavisine metilprednizolon eklendi. Steroid dozu azaltılırken göğüs ağrısı ve ateşinin tekrarlaması nedeniyle rekürren plörit-perikardit düşünüldü. Anakinra tedavisi başlandı ve tam yanıt ile beraber 41. haftaya dek alevlenme görülmedi. Sonuç: Olgularımızda yüksek ateş, serozit, yüksek AFR yanıtı gibi klinik ve laboratuvar özelliklerinin varlığı, patogenezde COVID-19 zemininde doğal immünitenin, özellikle kontrolsüz NLRP3 inflamazomu uyarısı ile artan IL-1ß'in rolünün olduğunu düşündürmektedir. COVID-19 veya aşıları sonrası gelişen RP olgularında steroid doz azaltımı sırasında perikardit bulguları tekrarlayan olgularda, anti-IL-1 tedaviler etkili olabilir. [ABSTRACT FROM AUTHOR]

Giriş: Koronavirüs hastalığı-2019 (COVID-19), dünya çapında yarattığı pandemi sonucunda yüz milyonlarca insanı etkilemiştir. COVID-19'a karşı geliştirilen aşılar şiddetli akut solunum sendromuna karşı en iyi kalkan olarak kabul edilmektedir. Aşılamayla gelişen gecikmiş tip deri reaksiyonları iyi tolere edilse de bazen kutanöz vaskülitlerin ortaya çıktığı veya var olan hastalığın alevlendiği bildirilmektedir. Bilim dalımızca izlenen iki olgunun sunumuyla birlikte, COVID-19'a karşı yapılan aşılama sonrasında literatürde bildirilen olgu serilerini (başlangıçtan Nisan 2022'e kadar) araştırarak, de novo gelişen vaskülit olgularına genel bir bakış sunma amaçlanmıştır. Olgu 1: Otuz yaşında önceden bir sağlık problemi olmayan erkek hasta. Ocak 2021 COVID-19 enfeksiyonu geçirmişti. Nisan 2021 tarihinde kırmızı renkli deri döküntüleri gerçekleşmişti. Bir-bir buçuk ay içinde kendiliğinden geçmişti. Haziran 2021'de ilk doz BioNTech COVID-19 aşısını olmuş ve problem yaşamamıştı. Eylül 2021'de 2. doz BioNTech COVID-19 aşısını olmuş ve 3 hafta sonra halsizlik, yorgunluk, kilo kaybı, sol ayak dorsal yüzde başlayan şişlik ve nekrotizan lezyonlar gelişmişti. Alınan biyopside immünokompleks birikimi gösteren küçük damar vasküliti tespit edildi. Olgu 2: Kırk sekiz yaşında kronik hastalık öyküsü olmayan kadın hasta. İki aydır olan konstitüsyonel semptomlar, kilo kaybı, halsizlik ve ateş şikayetleri ile başvurdu. Anamnezinde bize başvurusundan 6 ay önce asemptomatik COVID-19 enfeksiyon geçirdiğini belirtti. Şikayetlerinin 8 hafta önce, ilk doz BioNTech aşısından 2 hafta sonra başladığını ve ilk dozdan 6 hafta sonra ikinci doz aşısından sonra şikayetlerinin devam ettiğini belirtti. Akut faz yüksekliği de olan hastaya, yapılan PET-BT'de büyük damar vasküliti ile uyumlu bulgular tespit edildi. Literatür taramasında, aşılama sonrası de novo gelişen olguların derlendiği 69 makalede 80 vaskülit olgusu saptandı. Vaskülit alt grupları incelendiğinde, ilk sıralarda kutanöz lökositoklastik vaskülit (23/%29), ANCA ilişkili vaskülit (14/%18), IgA vasküliti (12/%15) ve kutanöz küçük damar vasküliti (12/%15) olduğu gözlendi. Bununla birlikte geniş bir yelpazede vaskülit alt grupları tespit edildi (Tablo 1). Sonuç: COVID-19 ve aşılamalar, farklı özelliklerde sistemik vaskülit riskini artırabilir. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Turkish Society for Rheumatology is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Turkish Society for Rheumatology is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Turkish Society for Rheumatology is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Turkish Society for Rheumatology is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

[Display omitted] • Tocilizumab, anakinra and prednisolone did not affect the antibody response to SARS-CoV-2. • The antibody response correlated with and could be predicted by involvement on thoracic CT. • The antibody level also correlated with the level of lung involvement on thoracic CT. Disease severity, previous medications and immunosuppressive agents could affect the antibody response against SARS-CoV-2. This study aimed to analyze variables affecting the humoral response to SARS-CoV-2. This prospective cohort study included adult patients who recovered from COVID-19 and were admitted to a COVID-19 follow-up unit. Eight patient groups were defined in accordance with the results of thoracic computed tomography (CT), SARS-CoV-2 PCR test, and tocilizumab or anakinra use during active disease. Anti-S IgG antibodies were determined by ELISA in serum samples. Anti-S positive and negative cases were compared. A total of 518 patients were included in the study. SARS-CoV-2 IgG antibodies were positive in 82.8% of patients. SARS-CoV-2 PCR positivity, extent of lung involvement on CT, and time to antibody testing were independently associated with antibody positivity. Tocilizumab, anakinra or prednisolone use was not a factor affecting the antibody response. The rate of antibody response and sample/CO values among antibody-positive patients showed a linear relationship with the extent of lung involvement on CT. The use of tocilizumab, anakinra and prednisolone for COVID-19 did not affect the antibody response against SARS-CoV-2. The main driver of antibody response among patients with COVID-19 was the extent of pulmonary involvement on CT. [ABSTRACT FROM AUTHOR]