SARS-CoV-2 Related ANCA-associated Vasculitis and Pauci-Immune Glomerulonephritis

Elli Novatcheva¹, Simranjit Randhawa¹, Aaron Safarian², Rocky Li³, Chukwuemeka Umeh¹, Ryan Basak¹, Pranav Barve¹, Sumanta Chaudhuri¹ and Sabina Kumar¹

¹Hemet Global Medical Center, Department of Internal Medicine, Hemet, CA, USA

²American University of Antigua College of Medicine, Saint Johns, AG

³Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, CA, USA

Cite this paper:
Elli Novatcheva, Simranjit Randhawa, Aaron Safarian, Rocky Li, Chukwuemeka Umeh, Ryan Basak, Pranav Barve, Sumanta Chaudhuri and Sabina Kumar. SARS-CoV-2 Related ANCA-associated Vasculitis and Pauci-Immune Glomerulonephritis. American Journal of Medical Case Reports. 2022; 10(5):122-127. doi: 10.12691/ajmcr-10-5-2

Abstract

COVID-19 is primarily a pulmonary disease characterized by both pulmonary and extrapulmonary complications. While acute respiratory distress syndrome (ARDS) is the most common pulmonary complication, acute kidney injury is the most common extrapulmonary complication of acute COVID-19. In addition, COVID-19 is associated with a cytokine storm capable of stimulating an autoimmune disorder. Here we present an unusual case of P-ANCA associated vasculitis and diffuse, pauci-immune rapidly progressive glomerulonephritis in a 24-year-old COVID-19 patient, resulting in an (AKI) requiring hemodialysis. The patient improved clinically after starting hydrocortisone and rituximab. She was, however, still dependent on hemodialysis at the time of hospital discharge.

Keywords:
SARS-CoV2 Vasculitis COVID-19 complications Pauci-Immune Glomerulonephritis

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	WHO Coronavirus (COVID-19) Dashboard [Internet]. [cited 2021 Dec 16]; Available from: https://covid19.who.int.
[2]	Provisional Mortality Data — United States, 2020 | MMWR [Internet]. [cited 2021 Dec 16]; Available from: https://www.cdc.gov/mmwr/volumes/70/wr/mm7014e1.htm?s_cid=mm7014e1_w.
[3]	Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020; 8(5): 475-81.
[4]	Nalbandian A, Sehgal K, Gupta A, et al. Post-acute COVID-19 syndrome. Nat Med 2021; 27(4): 601-15.
[5]	Liu Y, Sawalha AH, Lu Q. COVID-19 and autoimmune diseases. Curr Opin Rheumatol 2021; 33(2): 155-62.
[6]	Kim HJ, Yoo J, Jung SM, Song JJ, Park YB, Lee SW. Red Blood Cell Distribution Width Can Predict Vasculitis Activity and Poor Prognosis in Granulomatosis with Polyangiitis. Yonsei Med J 2018; 59(2): 294-302.
[7]	Kawamura T, Usui J, Kaneko S, et al. Anaemia is an essential complication of ANCA-associated renal vasculitis: a single center cohort study. BMC Nephrol 2017; 18: 337.
[8]	Izci Duran T, Turkmen E, Dilek M, Sayarlioglu H, Arik N. ANCA-associated vasculitis after COVID-19. Rheumatol Int 2021; 41(8): 1523-9.
[9]	Uppal NN, Kello N, Shah HH, et al. De Novo ANCA-Associated Vasculitis With Glomerulonephritis in COVID-19. Kidney Int Rep 2020; 5(11): 2079-83.
[10]	Moeinzadeh F, Dezfouli M, Naimi A, Shahidi S, Moradi H. Newly Diagnosed Glomerulonephritis During COVID-19 Infection Undergoing Immunosuppression Therapy, a Case Report. Iran J Kidney Dis 2020; 14(3): 239-42.
[11]	Jalalzadeh M, Valencia-Manrique JC, Boma N, Chaudhari A, Chaudhari S. Antineutrophil Cytoplasmic Antibody-Associated Glomerulonephritis in a Case of Scleroderma After Recent Diagnosis With COVID-19. Cureus [Internet] 2021 [cited 2021 Aug 15]; 13(1). Available from: https://www.cureus.com/articles/48374-antineutrophil-cytoplasmic-antibody-associated-glomerulonephritis-in-a-case-of-scleroderma-after-recent-diagnosis-with-covid-19.
[12]	Shah S, Danda D, Kavadichanda C, Das S, Adarsh MB, Negi VS. Autoimmune and rheumatic musculoskeletal diseases as a consequence of SARS-CoV-2 infection and its treatment. Rheumatol Int 2020; 1-16.
[13]	Puelles VG, Lütgehetmann M, Lindenmeyer MT, et al. Multiorgan and Renal Tropism of SARS-CoV-2. N Engl J Med 2020; 383(6): 590-2.
[14]	Gracia-Ramos AE, Saavedra-Salinas MÁ. Can the SARS-CoV-2 infection trigger systemic lupus erythematosus? A case-based review. Rheumatol Int 2021; 41(4): 799-809.
[15]	Söderberg D, Segelmark M. Neutrophil Extracellular Traps in ANCA-Associated Vasculitis. Front Immunol 2016; 7: 256.
[16]	Sharma P, Uppal NN, Wanchoo R, et al. COVID-19-Associated Kidney Injury: A Case Series of Kidney Biopsy Findings. J Am Soc Nephrol JASN 2020; 31(9): 1948-58.