The following is the summary of “Acute limb ischemia in an adolescent with COVID-19 and systemic scleroderma: a case report” published in the December 2022 issue of Pediatrics by Milan, et al.

Rarely seen in children, juvenile scleroderma is an autoimmune disorder of the connective tissues. When combined with COVID-19, which is also pro-inflammatory and pro-thrombotic, the result can be limb ischemia. Patients with juvenile Scleroderma and COVID-19 have not yet had a case report written about their symptoms and disease progression. A moderate, non-productive cough and extensive hypo- and hyperpigmented skin lesions were reported by the family of a teen diagnosed with acute limb ischemia.

Nasal swab Reverse Transcription – Polymerase Chain Reaction(RT-PCR) for  severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) was positive for her. Anti-phospholipid antibodies, anti-nuclear antibodies, and D-dimer were found to be increased, Protein S activity was low, and imaging examinations showed peripheral artery disease. Anticoagulation, Methotrexate, and peripheral vasodilators have been administered to her. Both the damaged limbs and the other organs were closely monitored. After 4 months of continuous Cyclophosphamide infusion, limb ischemia was under control. This patient will receive ongoing treatment from multiple specialists.

Their  understanding of how a COVID-19 hyperinflammatory state can contribute to rheumatologic diseases is expanding. Due to antigen protein mimicry and a cytokine imbalance, COVID-19 is considered to worsen the cutaneous symptoms of autoimmune diseases. In addition, the hypercoagulable state brought on by COVID-19 is the result of a series of intricate hematopathologic events. D-dimer levels are increased in both COVID-19 and systemic sclerosis because of the diseases’ pro-thrombotic consequences. Limited information is available linking COVID-19 protein activity to systemic sclerosis. There has to be more research done on the topic of thrombosis prophylaxis for people with Scleroderma and COVID-19 before a consensus can be reached.

Source: bmcpediatr.biomedcentral.com/articles/10.1186/s12887-022-03761-w