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Correspondence on ‘Lung involvement in macrophage activation syndrome and severe COVID-19: results from a cross-sectional study to assess clinical, laboratory and artificial intelligence–radiological differences’ by Ruscitti et al
  1. Acer I-Hung Chen1,
  2. Sheng-Chieh Lin2,3,
  3. James Cheng-Chung Wei3,4,5
  1. 1School of Medicine, Chang Gung University, Taoyuan City, Taiwan
  2. 2Department of Orthopedics, Chung Shan Medical University Hospital, Taichung, Taiwan
  3. 3Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
  4. 4Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
  5. 5Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
  1. Correspondence to Dr James Cheng-Chung Wei, Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan; jccwei{at}

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Our research team read Ruscitti et al’s article regarding lung involvement in coronavirus disease 2019 (COVID-19) and macrophage activation syndrome (MAS) with great interest.1 This topic not only addresses the current pandemic, but also is of concern in our team’s expertise—rheumatology. As we thoroughly examined the details of this research study, we noticed a few points we would like to address and discuss: the definition of patient selection criteria, the necessity of differentiating among COVID-19 CT patterns, the pathogenic mechanism differences between MAS and COVID-19, and the potential relationship between COVID-19 and vasculopathy.

First of all, this article states that age matching is not reliable. However, we contemplate that age is crucial in disease pathogenesis, such as immunosenescence, age-related inflammatory disease and periodontal disease, all of which could contribute to COVID-19 and MAS. Thus, “age” should still be an important factor to be considered and controlled as a confounding variable.2 3 In addition, we doubt about the accuracy of diagnosis based on Yamaguchi criteria, as they simply serve as preliminary criteria for adult-onset Still’s disease (AOSD),4 which may led to misclassification. …

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