Proceedings of the 29th European Paediatric Rheumatology Congress

P253 Raynaud’s phenomenon and ischemic fingers in a 6-year-old child: coagulopathy following COVID-19 or the first presentation of rheumatic disease: case report and literature review abstractM. Vahedi, A. MalekDepartment of Pediatrics, Mashhad University of Medical Sciences, Mashhad, Iran, Mashhad, Iran, Islamic Republic Of Correspondence: M. Vahedi Pediatric Rheumatology 2023, 21(Suppl 2):P253 Introduction: Secondary Raynaud's generally occurs in patients with autoimmune diseases,and prolonged finger ischemia will result in ischemic ulcers and tissue necrosis(1).Post-COVID-19 vasculitis and Hypercoagulability were reported(2). Digital necrosis has been described after COVID-19 in adults. Raynaud’s Phenomenon (RP) and digital ischemia following SARS-CoV-2 infection have not been reported in children(3). Objectives: The aim of our study is to highlight the possible role of post-COVID-19 hypercoagulable state and vasculitis in the development ischemic finger. Methods: A case report with a literature review Results: A 6-year-old girl presented with cyanosis in all fingers and toes for the past 8 days. She did not have any history of fever,rashes,or arthritis, and had no prior medical issues. The pain and cyanosis in her fingers and toes were triggered by exposure to cold.she had close contact with a person who tested positive for SARS-CoV-2 infection. Initially, we noticed discoloration in her digits, followed by evidence of necrosis, particularly on the pulp of her right middle finger and left middle toe. The results were negative for ANA,P-ANCA,C-ANCA, antiphospholipid antibodies. However, we did find leukocytosis and Eosinophilia in her peripheral blood smear. The results of the serum cryoglobulins and coagulation tests were normal. The SARS-CoV-2 RT-PCR was negative. Color Doppler ultrasonography of the extremities and an echocardiogram revealed normal findings. Despite the initial treatment with calcium channel blockers and aspirin, there was evidence of progressive finger ischemia. Therefore, sildenafil, captopril, and heparin infusion were added to her therapy after 12 hours. Due to refractory digital ischemia and suspected vasculitis, we started intravenous pulse methylprednisolone and azathioprine, which successfully stopped the progressive digital ischemia. We did not need to use prostacyclins. After 14 days,she was discharged with partial healing of the ischemic changes in her fingers and toes. Conclusion: Secondary Raynaud's is often associated with rheumatologic or thromboembolic disorders. We hypothesized that RP and finger ischemia may develop after a COVID-19 infection. Timely treatment of secondary RP and digital ischemia improves Patient Outcomes. In patients with suspected vasculitis, The early initiation of corticosteroids improves prognosis and may reduce intravenous prostacyclin use. Patient Consent Yes, I received consent Disclosure of Interest None declared References 1. Choi E,Henkin S.Raynaud’s phenomenon and related vasospastic disorders. Vascular Medicine.2021;26(1):56-70. 2. Wong K,Shah MUFA, Khurshid M,Ullah I, Tahir MJ,Yousaf Z.COVID-19 associated vasculitis:a systematic review of case reports and case series. Annals of medicine and surgery.2022:103249. 3. Abou-IsmailMY,Diamond A,Kapoor S,ArafahY,Nayak L. The hypercoagulable state in COVID-19:Incidence,pathophysiology,and management. Thrombosis research. 2020;194:101-15.