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.
【저자키워드】 COVID-19, SARS-CoV-2, Case report, Anti-GBM disease, Glomerulonephritis, 【초록키워드】 IgG, IgM, SARS-COV-2 infection, pulmonary, Steroids, rituximab, dialysis, Kidney injury, kidney, Autoimmune disease, Anti-GBM disease, Glomerulonephritis, cycle threshold, plasma exchange, Patient, membrane, plasma, recurrence, disease, pulmonary disease, rapidly progressive glomerulonephritis, Plasma cells, Dyspnoea, association, dose, SARS-CoV-2 PCR, autoantibody, medical history, basement membrane, Support, crescentic glomerulonephritis, syndrome, pulmonary involvement, pulmonary infiltrates, haemoptysis, assumption, renal, positive, long-lived plasma cells, past medical history, alveolar, resulting, caused, the patient, remained, diagnosed, linear, treated, resolved, glomerular, pulmonary infiltrate, undetectable,