Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis presented as pulmonary-renal syndrome in a coronavirus disease-2019 (COVID-19) patient

Apaydin, Hakan; Can Güven, Serdar; Doğan, İsmail; Çolak, Aysel; Süngü, Nuran; Erten, Şükran

Introduction Coronavirus disease 2019 (COVID-19) is a global pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). The SARS-CoV-2 virus primarily targets the respiratory system, but extrapulmonary involvement can be frequently seen. Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is systemic autoimmune disease 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 SARS-CoV-2 infection may trigger the presentation or exacerbation of autoimmune diseases. Case report: A case of AAV, manifesting as diffuse alveolar hemorrhage and rapidly progressive kidney disease after COVID-19 infection has been presented. At presentation, the patient had rapidly progressive kidney disease and active urinary sediment; chest computerized tomography (CT) findings primarily suggested alveolar hemorrhage with a positive serum proteinase 3-ANCA (PR3-ANCA) test. The patient was considered as AAV associated pulmonary-renal syndrome possibly triggered by COVID-19 infection. The patient received pulse corticosteroids, plasma exchange and intravenous immunoglobulin as treatment. Mycophenolate mofetil was added as an immunosuppressive therapy. After 6 months, kidney functions completely recovered. Conclusion: This case highlights that SARS-CoV-2 disease could be the trigger for AAV, and this should be kept in mind in such cases. Early detection of AAV is important in cases infected or co-infected with COVID-19, and prompt diagnosis and appropriate management of AAV-associated pulmonary-renal syndrome are essential to reduce the morbidity and mortality.