Endothelial cell inflammation, apoptosis and dysfunction occur in patients with COVID-19 [37]. The interface of endothelial cells and viruses is of longstanding interest. For example, a major viral attachment and entry site for viruses is heparan sulfate. This is found on the endothelial surface and consists of repeating disaccharide unites of glucosamine and uronic acid with interspaced sulfate group attachments (reviewed in Agelidis) [53]. The highly sulfated state results in a negative density and binding capacity for a variety of positively charged ligands. A partial but representative summary of individual sites of vasculitis is provided (Table 1) [54–69].
Table 1 COVID-19 vasculitis
Patient (n) Age (Y) Sex Country Organ system Signs and symptoms Diagnostic test Treatment Outcomes References
1 69 M Brazil CNS (VBS) Trochlea
Nerve palsy MRI
MR IV Methyl-prednisone Resolved De Oliveira
1 NR NR NR CNS Corpus Callosum infarct MRI NR NR Varatharaj
7 11–17 4M
3F Spanish Skin Chilblains
“COVID-Toes” Biopsy Observation Resolved
8 weeks Colmenero
17 15–63 11M
6F France Skin Chilblains
Toes, heels, fingers Biopsy N NR Kanitakis
19 11–17 14M
5F Italy Skin Chilblains
Toes, heels, soles Biopsy NR Resolution
>30days El-Hachem
1 65 M France CNS Altered mental status MRA
MRI Supportive NR Hanafi
1 50 M Asia Kidney
Liver
Lung Sepsis
Hypoxia Necropsy
Biopsy Supportive Deceased Xu
1 NR NR NR GI Tract Diarrhea Biopsy Supportive Recovered Carnevale
10 5–16 7M
3F Italy Coronary
Arteries Fever
Skin rash
Diarrhea
Hypotension Clinical
Echocardiography IVIG
Aspirin Recovered Verdoni
1 > 53 NR Switzerland Lung Dyspnea
Fever Necropsy NR Deceased Menter
4 50–76 3M
1F Spain Aorta Acute Limb
Ischemia
Stroke CTA Thrombectomy
Anticoagulation 3 discharged
1 deceased Gomez Arbelaez -
1 67 M Italy Aortic Prosthetic graft Respiratory failure Arterial Duplex Supportive Deceased Giacomelli
2 60, 75 M UK Mesentery
Aorta Acute Limb ischemia
Abdominal pain CTA
CTA Thrombectomy
Bowel Resection Discharged Villliany
5 57–71 3M 2F France Aorta Acute limb ischemia CTA
Arterial Duplex Surgery
Anticoagulation Amputation Kashi
1 NR NR Spain Retinal Artery No symptoms Fundoscopy Observation No symptoms Quintana-Castanedo
VBS vertebrobasilar system, NR not reported, IVIG intravenous immunoglobulin, CTA Computed Tomography Angiography, UK United Kingdom