Reply

To the Editor:

We are grateful to Drs. Kardaş and Küçük for the interest shown in our article and for their comments. We are happy to supply additional information to address the questions posed.

First, we would like to provide clarification on the comment “9% of patients with COVID‐19 in this study had a negative SARS–CoV‐2 polymerase chain reaction result.” Of the patients in our study population, 9% (6 of 65 patients) were reported as having clinical or radiologic evidence supporting the diagnosis of COVID‐19, but information regarding whether a polymerase chain reaction (PCR) test was undertaken for these patients was not available to us except in the case of 1 patient who did have a negative test result at the time of case report form submission. However, the reporting physicians were confident in the diagnosis based on relevant features identified by clinical examination and computed tomography scan.

Regarding whether cases were investigated for other causes of respiratory infections, reporting physicians were asked about the presence of concomitant respiratory tract infection. In the 28% of patients (18 of 65) who did not have a definite PCR‐confirmed diagnosis, no other specific respiratory pathogens were reported. Of those patients, 4 of 18 had secondary, presumed bacterial pneumonia. However, data in this section of the case report form were missing for approximately one‐half of the patient population.

The Birmingham Vasculitis Activity Score (BVAS) instrument (1) was available for the reporting physician to complete, but it was an optional component of the case report form due to the clinical pressures of the pandemic. Of the 65 patients included in the cohort, BVAS data were provided for 28 (43%), but this was not included in the analysis as the proportion of missing data was deemed too high.

Of the patients who died, 11 of 18 were deemed to be in remission by the treating clinician at the time of COVID‐19 diagnosis, 5 of 18 had moderate disease activity, and 2 of 18 had minimal disease activity. The cause of death in all patients was deemed likely, or highly likely, to be attributable to COVID‐19. Clinical information was incomplete for 1 patient; this patient's death was presumed to be attributable to COVID‐19, and there was no mention of active vasculitis at any point in the case report form. In 1 other patient, active vasculitis was considered to be the possible cause of death, but on balance, COVID‐19 was deemed the more likely cause.