Celiac artery vasculitis associated with post covid syndrome: a diagnosis of exclusion

Abstract

Introduction: Vasculitis are a heterogeneous group of diseases whose main characteristic is inflammation and necrosis of the blood vessel wall. More than 30 types of vasculitis are known, whose origin may be primary: unknown, or secondary to an infectious agent. SARS-CoV-2 is the third coronavirus to spread globally and to cause severe disease in humans. Due to endothelial damage caused by virus invasion, cases of leukocytoclastic vasculitis, associated with positive anca, immunoglobulin A and Kawasaki disease have been reported. Case report: We report the case of a 41-year-old male patient who presented symptoms characterized by general discomfort, headache, stuffy nose, unquantified febrile fever. He refers probable epidemiological contact of SARS CoV-2 at work. Ten days after viral infection, he sudden started epigastric pain of strong intensity, which was partially attenuated with antispasmodic. He went to the emergency room on 2 occasions, where there was evidence of painful abdomen on diffuse palpation, leukocytosis of 13200 cells/mm3, with neutrophilia of 86.9%. An abdominal ultrasound reported acalculous cholecystitis. On the second occasion, the patient attended for exacerbation of pain intensity. Paraclinical findings: neutrophilia of 76%, ESR and CRP slightly elevated. CT study denotes decreased hepatic artery caliber and splenic artery dissection. Conclusions: We obtained 2 rare clinical manifestations associated with post-covid syndrome: acalculous cholecystitis and celiac trunk arteritis.  The presence of the angiotensin-converting enzyme 2 receptor in tissues such as vascular endothelium, smooth muscle, biliary tree and colonic mucosa is fundamental in the pathophysiology of COVID-19 infection and its subsequent complications.