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Review
. 2021 Aug;41(8):1523-1529.
doi: 10.1007/s00296-021-04914-3. Epub 2021 Jun 7.

ANCA-associated vasculitis after COVID-19

Tugba Izci Duran  1 , Ercan Turkmen  2 , Melda Dilek  2 , Hayriye Sayarlioglu  2 , Nurol Arik  2
Affiliations
Review

ANCA-associated vasculitis after COVID-19

Tugba Izci Duran et al. Rheumatol Int. 2021 Aug.

Abstract

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) are systemic autoimmune diseases that may lead to renal failure due to the infiltration of mononuclear cells and the destruction of small- and medium-sized blood vessels. It has been shown that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may trigger the presentation or exacerbation of autoimmune diseases. Crescentic glomerulonephritis (GN) has rarely been reported in patients with Coronavirus disease-2019 (COVID-19). We present rare two cases with AAV after a recent diagnosis of COVID-19. The first case was 26-year-old male patient, who was presented with acute kidney injury after COVID-19. Serum creatinine increased and active urine sediment was seen. Serological evaluation showed anti-myeloperoxidase antibody was at a level of 80.6 U/mL. Kidney biopsy showed necrotizing GN with cellular crescents. Methylprednisolone, cyclophosphamide and plasma exchange were administered. He was discharged with hemodialysis. Second case was a 36-year-old female who was hospitalized because of fever, cough and dyspnea. After she was diagnosed with COVID-19, she had total hearing loss, with cavitary lesions on bilateral lung parenchyma and an acute kidney injury. Serological evaluation showed an elevated anti-proteinase-3 with a level of 1:32. Kidney biopsy showed necrotizing GN with cellular crescents. Renal function improved after methylprednisolone and cyclophosphamide treatment. With a systematic review of the literature, we found four cases of new-onset AAV due to COVID-19. Herein, we discuss two cases and provide a literature review on cases of new-onset pauci-immune GN after COVID-19 infection.

Keywords: Anti-neutrophil cytoplasmic antibody-associated vasculitis/diagnosis*; COVID-19; Glomerulonephritis/pathology*; SARS-CoV-2*.

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Conflict of interest statement

All the authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Thoracic computed tomography images of Case 1. A Diagnosis of COVID-19 was established based upon peripheral and mainly posteriorly located GGOs. B After favipiravir treatment, lung findings such as GGOs regressed. C On the thoracic CT after the patient had cough and dyspnea again, diffuse acinar alveolar opacities and GGOs were observed in both lungs, which were more prominent in the central perihilar areas
Fig. 2
Fig. 2
Thoracic computed tomography images of Case 2, before and after immunosuppressive therapy. A Thoracic CT taken a couple of weeks after the confirmation of COVID-19 infection, on which the bilateral pleural effusion and perihilar cavitation can be observed. B Regression of pleural effusion and GGOs during the first week of immunosuppressive treatment given after the diagnosis of AAV
See this image and copyright information in PMC

References

    1. Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, Flores-Suarez LF, Gross WL, Guillevin L, Hagen EC, Hoffman GS, Jayne DR, Kallenberg CG, Lamprecht P, Langford CA, Luqmani RA, Mahr AD, Matteson EL, Merkel PA, Ozen S, Pusey CD, Rasmussen N, Rees AJ, Scott DG, Specks U, Stone JH, Takahashi K, Watts RA. 2012 Revised international chapel hill consensus conference nomenclature of vasculitides. Arthritis Rheum. 2013;65(1):1–11. doi: 10.1002/art.37715. - DOI - PubMed
    1. Gómez-Puerta JA, Gedmintas L, Costenbader KH. The association between silica exposure and development of ANCA-associated vasculitis: systematic review and meta-analysis. Autoimmun Rev. 2013;12(12):1129–1135. doi: 10.1016/j.autrev.2013.06.016. - DOI - PMC - PubMed
    1. Somer T, Finegold SM. Vasculitides associated with infections, immunization, and antimicrobial drugs. Clin Infect Dis. 1995;20(4):1010–1036. doi: 10.1093/clinids/20.4.1010. - DOI - PubMed
    1. Kallenberg CG. The role of bacterial infections for the initiation and exacerbation of systemic vasculitis. Autoimmun Rev. 2004;3(Suppl 1):S45–47. - PubMed
    1. Peschel A, Basu N, Benharkou A, Brandes R, Brown M, Rees AJ, Kain R. Autoantibodies to hLAMP-2 in ANCA-negative pauci-immune focal necrotizing GN. J Am Soc Nephrol. 2014;25(3):455–463. doi: 10.1681/asn.2013030320. - DOI - PMC - PubMed

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