Granulomatosis with Polyangiitis following COVID-19 in an Adolescent

Abstract

Granulomatosis with polyangiitis (GPA) is a systemic disease that causes vasculitis in various organs. Although the mechanism of pathogenesis remains unclear, infection has been reported to be a causative factor. We herein report a case of GPA that developed following coronavirus disease 2019 (COVID-19) in an adolescent girl. One month after contracting mild COVID-19, the patient had facial allodynia, a fever, and weight loss and was admitted for multiple nodular shadows on a chest roentgenogram. GPA was diagnosed based on pathological findings of the lung and nasal mucosal biopsies. She received methylprednisolone and rituximab, and her symptoms and radiological findings improved.

Keywords: coronavirus disease 2019; facial allodynia; granulomatosis with polyangiitis; multiple lung nodules; proteinase-3-antineutrophil cytoplasmic antibody; rituximab.

Figure 1.

Chest radiography findings. Chest radiography on admission revealed multiple nodular shadows as well as a mass shadow in the right lower lung (A), which markedly shrank after treatment with prednisolone and rituximab (B).

Figure 2.

Chest computed tomography on admission. Chest computed tomography on admission showed multiple nodular shadows, including a mass shadow with ground-glass opacities in the right lower lobe.

Figure 3.

Pathological findings of the lung biopsy. Lung pathology showed infiltration of neutrophils, lymphocytes, histiocytes, and multinucleated giant cells around the necrotic area (A) as well as segmental and eccentric vasculitis with a disrupted vascular wall structure (arrows) (B). Elastica-Masson staining revealed disruption of the elastic lamina (arrow heads), suggesting necrotizing granulomatous vasculitis (C). Numerous multinucleated giant cells with intense nuclear chromatin staining (arrowheads) and granulomatous inflammation with neutrophil and lymphocyte accumulation are observed in the surrounding area (D).

Figure 4.

Pathological findings of the nasal septal mucosal biopsy. The nasal septal mucosal biopsy showed formation of granulation tissue exhibiting a degree of chronic inflammation and neutrophilic infiltration, but necrosis was not evident.