SARS-CoV-2 infection and recurrence of anti-glomerular basement disease: a case report

Abstract

Background Anti-glomerular basement membrane disease (GBM) disease is a rare autoimmune disease causing rapidly progressive glomerulonephritis and pulmonary haemorrhage. Recently, an association between COVID-19 and anti-glomerular basement membrane (anti-GBM) disease has been proposed. We report on a patient with recurrence of anti-GBM disease after SARS-CoV-2 infection. Case presentation The 31-year-old woman had a past medical history of anti-GBM disease, first diagnosed 11 years ago, and a first relapse 5 years ago. She was admitted with severe dyspnoea, haemoptysis, pulmonary infiltrates and acute on chronic kidney injury. A SARS-CoV-2 PCR was positive with a high cycle threshold. Anti-GBM autoantibodies were undetectable. A kidney biopsy revealed necrotising crescentic glomerulonephritis with linear deposits of IgG, IgM and C3 along the glomerular basement membrane, confirming a recurrence of anti-GBM disease. She was treated with steroids, plasma exchange and two doses of rituximab. Pulmonary disease resolved, but the patient remained dialysis-dependent. We propose that pulmonary involvement of COVID-19 caused exposure of alveolar basement membranes leading to the production of high avidity autoantibodies by long-lived plasma cells, resulting in severe pulmonary renal syndrome. Conclusion Our case supports the assumption of a possible association between COVID-19 and anti-GBM disease.

Temporal Clustering of Antiglomerular Basement Membrane Disease in COVID-19 Pandemic: A Case Series

“…Recurrence of anti-GBM disease post-COVID -19, a 30-year-old woman with hemoptysis and rapidly progressive renal failure has also been reported. 8 None of the anti-GBM disease cases reported by Prendecki et al had hemoptysis, which is similar to our case series. Spatial and temporal variations and their association with an increase in the incidence of anti-GBM disease show environmental factors may play a role in causation.…”

Nephrotic syndrome and vasculitis following SARS-CoV-2 vaccine: true association or circumstantial?

“…COVID-19 may be one such infection [ 32 , 33 ], as suggested by a report of a cluster of cases in London during the current pandemic [ 34 ] with a 5-fold increased incidence. Although five of eight tested patients presenting with anti-GBM Ab were negative for SARS-CoV-2 infection by PCR, four had IgM and/or IgG Abs to SARS-CoV-2 S protein, raising the possibility that immune response to SARS-CoV-2 could be related to development of anti-GBM in some patients [ 34 ].…”

Epidemiology, Impact, and Management Strategies of Anti-Glomerular Basement Membrane Disease

“… 18–20 A case of recurrence of anti-GBM disease presenting with pulmonary hemorrhage and crescentic GN following COVID-19 has also been described. 21 Several cases of anti-GBM disease related to SARS-CoV-2 vaccination have been published recently. 22–24 Although a temporal relationship has been noted, there is insufficient evidence to postulate causality.…”