Antineutrophil Cytoplasmic Antibody-Associated Glomerulonephritis in a Case of Scleroderma After Recent Diagnosis With COVID-19

Abstract

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare occurrence in systemic sclerosis (SSc) patients. AAV is an inflammatory disease that can lead to kidney failure due to the infiltration of mononuclear cells and the destruction of blood vessels. Also, crescentic glomerulonephritis (GN) has rarely been reported with coronavirus disease 2019 (COVID-19) and acute tubular injury is the most common renal pathology lesion in these patients. We present a rare case of a 46-year-old woman with SSc with new onset of renal failure after a recent diagnosis of COVID-19. Her serology was positive for p-ANCA and myeloperoxidase antibodies. Kidney biopsy was done and showed crescentic GN. We suggest during this pandemic, patients with an immunological disorder that are infected with COVID-19 be closely monitored for any organ involvement.

ANCA-associated vasculitis after COVID-19

“…Immunological tests showed positive p-ANCA in three cases (the present report (PR) and [ 15 , 17 ]) and positive c-ANCA in three cases ([ 15 , 16 ] and PR). Imaging studies showed patchy GGOs in five cases ([ 15 , 17 ] and PR), bilateral pleural effusion in two cases ([ 17 ] and PR), alveolar hemorrhage in one case [ 16 ], and bilateral cavitary lesions in one case (PR). Treatment for COVID-19 was administered in five patients, favipiravir in one case (PR), tocilizumab and convalescent plasma in one case [ 15 ], and hydroxychloroquine in two cases [ 15 , 16 ].…”

“…With the present report, we identified 3 reports describing cases of AAV after COVID-19 and the table includes an update of the published cases written in English [ 15 – 17 ] (Table 1 ). In the literature, a total of four different cases of AAV developed after COVID-19 have been reported, including one from Iran and three from the USA [ 15 – 17 ]. A total of six cases were included in this review.…”

“…Of the six patients (including ours), four (66.6%) were men with a mean age of 40.5 ± 14.7. There was one case (16.6%) diagnosed with systemic sclerosis prior to COVID-19 [ 17 ]. Immunological tests showed positive p-ANCA in three cases (the present report (PR) and [ 15 , 17 ]) and positive c-ANCA in three cases ([ 15 , 16 ] and PR).…”

“…There was one case (16.6%) diagnosed with systemic sclerosis prior to COVID-19 [ 17 ]. Immunological tests showed positive p-ANCA in three cases (the present report (PR) and [ 15 , 17 ]) and positive c-ANCA in three cases ([ 15 , 16 ] and PR). Imaging studies showed patchy GGOs in five cases ([ 15 , 17 ] and PR), bilateral pleural effusion in two cases ([ 17 ] and PR), alveolar hemorrhage in one case [ 16 ], and bilateral cavitary lesions in one case (PR).…”

“…Although cases of kidney damage due to COVID-19 have been reported, an association between COVID-19 and crescentic GN has been rarely identified. To date, only four cases of AAV with COVID-19 have been reported [ 15 – 17 ]. Herein, we aimed to discuss 2 cases and provide a literature review on cases of new-onset pauci-immune GN after COVID-19 who clinically improved with immunosuppressants therapy and review the previous studies including similar cases.…”