Iran J Pediatr. 2021 June; 31(3):e110597. Published online 2021 May 12. doi: 10.5812/ijp.110597. Case Report Could COVID-19 Trigger Presentation or Exacerbation of Vasculitides? (A 14-Year-Old Girl with Newly Diagnosed GPA After COVID-19 Infection) Seyed Reza Raeeskarami 1 , Seyyed Hosein Mousavi 2 , Mohammad Ashouri 3 , Parvin Akbariasbagh 1 , Raheleh Assari 4, 5 and Sahar Naderi 4, 5, * 1 Department of Pediatrics, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran 2 Department of Cardiology, AJA University of Medical Sciences, Tehran, Iran 3 Department of Surgery, Imam Khomeini Hospital, Tehran University of Medical Scienses, Tehran, Iran 4 Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran 5 Children’s Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran * Corresponding author: Department of Pediatrics, Pediatrics Center of Excellence, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Email: sahar.naderi83@gmail.com Received 2020 October 25; Revised 2020 November 30; Accepted 2021 January 23. Abstract Introduction: Granulomatosis with polyangiitis (GPA) is a kind of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculi- tis (AAV), which involves small-to-medium-sized vessels. Besides, GPA usually involves the upper and lower respiratory tract, and also causes necrotizing glomerulonephritis. The involvement of the heart and gastrointestinal (GI) tract in GPA is unusual, and these are atypical places of this vasculitis. Case Presentation: A 14-year-old girl with a newly diagnosed GPA after afflicting with COVID-19 infection presented with ST-elevation Myocardial Infarction (MI), GI perforation, and intracranial hemorrhage. Conclusions: Although GPA is rare in the pediatric population, it might occur in this age group and could involve multiple organ systems. Keywords: Granulomatosis with Polyangiitis, COVID-19, Myocardial Infarction, Gastrointestinal Perforation, Intracranial Hemorrhage 1. Introduction Granulomatosis with polyangiitis (GPA), formerly known as Wegener’s disease, is a kind of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), which involves small-to-medium-sized vessels (1). Besides, GPA is a necrotizing granulomatous inflammation, usu- ally involving the upper and lower respiratory tract, and also causing necrotizing glomerulonephritis (2). The involvement of the heart and Gastrointestinal Tract (GI) tract in GPA is unusual, and these are atypical places of this type of vasculitis (3, 4). The cardiac manifestations are not often clinically obvious, but they can increase the mortality rate (5). Although the involvement of GI is rare, perforation is one of the frequently described patholo- gies in GPA patients (4). We herein report a 14-year-old girl with a newly diagnosed GPA after COVID-19 infection who presented with ST-elevation MI, GI perforation, and intracranial hemorrhage. 2. Case Presentation The patient was a 14-year-old girl who presented with symptoms of respiratory tract infection in June 2020 and was treated with the diagnosis of acute. Three weeks later, she developed the symptoms of pain and swelling in dif- ferent joints, with migratory patterns and occasional fever. Because of these complaints, the patient was admitted to a hospital for diagnostic evaluations. According to her recent respiratory symptoms and COVID-19 outbreak, she was evaluated for COVID-19. The RT-PCR and Ig M were neg- ative, but the IgG level was positive (IgG = 4.2). A chest CT scan (Figure 1) was performed, which showed bilateral multifocal nodular infiltrates with halo sign view, which was suggestive of vasculitis in particular GPA. Also, there were subpleural consolidation foci and centrilobular nod- ules, which could be in the context of bronchopneumo- nia in Coronavirus infection background. According to si- nusitis history, chest CT scan evidence, and arthritis, the Copyright © 2021, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.