ANCA-associated vasculitis flare might be provoked by COVID-19 infection: a case report and a review of the literature

Abstract

Mesangial IgA deposition is the hallmark of IgA nephropathy. In some cases, crescentic involvement which might be associated with systemic leukocytoclastic vasculitis is documented; in such cases, the disease is called Henoch-Schonlein purpura (IgA vasculitis). Even more rarely, the coexistence of IgA nephropathy and ANCA seropositivity was reported. IgA nephropathy might be complicated by acute kidney injury due to different causes. Herein, we present a patient with mesangial IgA deposition and ANCA seropositivity, who developed acute kidney injury, hematuria, and hemoptysis during the course of COVID-19 disease and was diagnosed with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis based on clinical, laboratory, and radiological findings. The patient was treated successfully with immunosuppressive therapy. We also made a systematic review of the literature to reveal and present the cases with COVID-19 and ANCA-associated vasculitis.

Double-Positive Anti–Glomerular Basement Membrane Antibody and Myeloperoxidase Antineutrophil Cytoplasmic Autoantibody–Associated Glomerulonephritis Post COVID-19 mRNA vaccine: A Case Series of 4 Patients

“…There is at least 1 case reported of dual anti-GBM and ANCA nephritis following COVID-19 infection. 22 There are also at least 20 cases reported so far of ANCA nephritis following COVID-19 infection 23 and evidence that the frequency of anti-GBM increased with the advent of the COVID-19 pandemic prior to the distribution of COVID-19 vaccines. 24 …”

“…There is at least 1 case reported of dual anti-GBM and ANCA nephritis following COVID-19 infection. 22 There are also at least 20 cases reported so far of ANCA nephritis following COVID-19 infection 23 and evidence that the frequency of anti-GBM increased with the advent of the COVID-19 pandemic prior to the distribution of COVID-19 vaccines. 24 Once glomerular or pulmonary capillary endothelial damage occurs, this exposes basement membrane antigens to this same immunogenic environment, allowing for epitope spreading to occur.…”

Multi-Organ Relapse following COVID-19 in Myeloperoxidase-Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis: A Case Report

“…When patients with AAV progress to ESKD, vasculitis relapse is rare. However, SARS-CoV-2 infection can potentially trigger autoimmune diseases, including AAV [ 3 ]. We present an exceptional case of vasculitis relapse involving multiple organs, initially involving the gastrointestinal (GI) system and subsequently progressing to the pulmonary system.…”

“…The two potential reasons for this observation are as follows: (a) owing to its impaired function, the kidney is no longer susceptible to AAV relapse; (b) the impaired immune response due to kidney failure may lead to a potential reduction in disease activity, similar to that observed in systemic lupus erythematosus [ 2 ]. Moreover, coronavirus disease 2019 (COVID-19) reportedly induces or worsens autoimmune diseases, with some cases in the literature suggesting that it may trigger new onsets or flares of AAV [ 3 ]. Herein, we present an unusual case of multi-organ relapse in a patient with MPO-AAV who underwent maintenance hemodialysis following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.…”

New‐onset ANCA‐associated vasculitis presenting with neuropathy after COVID‐19 infection: A case report and literature review

“…Glomerulonephritis (GN) and diffuse alveolar hemorrhage (DAH) are common presentations in post-COVID AAV patients while neurologic symptoms are very rare and have been reported in only three patients until now. [3][4][5][6][7] This study discusses a case with neuropathy and positive ANCA after COVID-19 infection.…”