Review
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2020; 8(17): 3621-3644
Published online Sep 6, 2020. doi: 10.12998/wjcc.v8.i17.3621
Autoimmunity as the comet tail of COVID-19 pandemic
Rossella Talotta, Erle Robertson
Rossella Talotta, Department of Clinical and Experimental Medicine, Rheumatology Unit, AOU “Gaetano Martino”, University of Messina, Messina 98100, Italy
Erle Robertson, Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19014, United States
Author contributions: Talotta R conceived the idea for the manuscript, reviewed the literature and drafted the manuscript; Robertson E critically revised the paper; all the authors approved the final version of the manuscript.
Conflict-of-interest statement: The author declares no conflict of interests.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Rossella Talotta, MD, PhD, Senior Researcher, Department of Clinical and Experimental Medicine, Rheumatology Unit, AOU “Gaetano Martino”, University of Messina, via Consolare Valeria 1, Messina 98100, Italy. talotta1@virgilio.it
Received: July 4, 2020
Peer-review started: July 4, 2020
First decision: July 24, 2020
Revised: July 29, 2020
Accepted: August 26, 2020
Article in press: August 26, 2020
Published online: September 6, 2020
Processing time: 61 Days and 20.8 Hours
Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can give rise to different clinical manifestations that are directly related to viral tissue damage or indirectly induced by the antiviral immune response. Hyper-activation of the immune system in an attempt to eradicate the infection may trigger autoimmunity. Several immune-mediated disorders have been described in SARS-CoV-2-infected individuals. These include cutaneous rashes and vasculitis, autoimmune cytopenia, anti-phospholipid syndrome, central or peripheral neuropathy, myositis and myocarditis. On the other hand, rheumatic patients were reported to have similar coronavirus disease 2019 (COVID-19) incidence, morbidity and mortality rates compared to general population. This opinion review will summarize the crucial immunologic steps which occur during SARS-CoV-2-infection that may link autoimmunity to COVID-19 and provides an opportunity for further discussion regarding this association.

Keywords: COVID-19; SARS-CoV-2; Autoimmunity; Autoimmune diseases; Rheumatic diseases; Host-virus interaction

Core tip: The immune system plays a central role in coronavirus disease 2019 (COVID-19), being responsible for clinical manifestations and prognosis. Hyper-activation of the immune response against severe acute respiratory syndrome coronavirus 2 may result, in some cases, in development of unwanted autoimmune disorders. COVID-19 has been associated with immune-mediated systemic or organ-selective manifestations, some of which fulfill the diagnostic or classification criteria of specific autoimmune diseases. Though it is still unknown whether these medical conditions represent transitory post-infectious epiphenomena, the use of therapeutic agents targeting the immune system may perhaps prevent their chronicization which leads to development of autoimmune diseases.