High levels of anti-SSA/Ro antibodies in COVID-19 patients with severe respiratory failure: a case-based review
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CASE BASED REVIEW
High levels of anti-SSA/Ro antibodies in COVID-19 patients with severe respiratory failure: a case-based review High levels of anti-SSA/Ro antibodies in COVID-19 Hiroyuki Fujii 1 & Taisuke Tsuji 1 & Tatsuya Yuba 1,2 & Shunya Tanaka 1 & Yoshifumi Suga 1 & Aosa Matsuyama 1 & Ayaka Omura 1 & Shinsuke Shiotsu 1,3 & Chieko Takumi 1,3 & Seiko Ono 1,2 & Masahito Horiguchi 4 & Noriya Hiraoka 1 Received: 2 August 2020 / Revised: 18 August 2020 / Accepted: 20 August 2020 # International League of Associations for Rheumatology (ILAR) 2020
Abstract We treated two patients with severe respiratory failure due to coronavirus disease 2019 (COVID-19). Case 1 was a 73-year-old woman, and Case 2 was a 65-year-old-man. Neither of them had a history of autoimmune disease. Chest computed tomography scans before the antiviral therapy showed bilateral multiple patchy ground-glass opacities (GGO) consistent with COVID-19 pneumonia. The GGO regressed over the course of the antiviral treatment; however, new non-segmental patchy consolidations emerged, which resembled those of interstitial lung disease (ILD), specifically collagen vascular disease-associated ILD. We tested the patients’ sera for autoantibodies and discovered that both patients had high anti-SSA/Ro antibody titers. In Case 1, the patient recovered with antiviral therapy alone. However, in Case 2, the patient did not improve with antiviral therapy alone but responded well to corticosteroid therapy (methylprednisolone) and made a full recovery. The relationship between some immunological responses and COVID-19 pneumonia exacerbation has been discussed previously; our discovery of the elevation of anti-SSA/Ro antibodies suggests a contribution from autoimmunity functions of the immune system. Although it is unclear whether the elevation of anti-SSA/Ro antibodies was a cause or an outcome of aggravated COVID-19 pneumonia, we hypothesize that both patients developed aggravated the COVID-19 pneumonia due to an autoimmune response. In COVID-19 lung injury, there may be a presence of autoimmunity factors in addition to the known effects of cytokine storms. In patients with COVID-19, a high level of anti-SSA/Ro52 antibodies may be a surrogate marker of pneumonia severity and poor prognosis. Keywords Anti-SSA/Ro antibodies . Coronavirus disease 2019 (COVID-19) . Corticosteroid . Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
Introduction Since December 2019, the world has been confronted with the emergence of the novel coronavirus disease 2019 (COVID-
* Hiroyuki Fujii [email protected]
19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). As of July 25, 2020, 15,581,009 cases were reported, including 635,173 deaths in 216 countries [1]. To date, our hospital in Kyoto, Japan, has admitted 25 patients with confirmed COVID-19. This report describes two patients with severe respiratory failure due to COVID-19 that was associated with high levels of serum antiSSA/Ro antibodies, a type of antinuclear autoantibody that is as
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