The coronavirus disease 2019 (COVID-19) has caused many different complications including immune-related conditions. Hereby, we report a case of a possible association between COVID-19 infection and de novo anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis presenting with severe pulmonary-renal syndrome as a rare complication of COVID-19 infection. We had a 53-year-old male patient who was admitted for a severe COVID-19 pneumonia complicated by septic shock and acute respiratory distress syndrome. He responded to the standard treatments and was discharged. Four months later, he was admitted with a severe acute pulmonary-renal syndrome (severe acute on chronic kidney failure with active sediment and proteinuria, and diffuse alveolar hemorrhage (DAH) requiring mechanical ventilation). Kidney biopsy confirmed pauci-immune fibro-cellular crescentic glomerulonephritis on top of glomerular sclerosis. Perinuclear-ANCA and anti-myeloperoxidase antibody came back positive. Pulse steroids and cyclophosphamide were administered. Given the chronicity of the kidney lesions, the kidney function did not improve significantly, and the patient became dialysis dependent; however, respiratory status responded dramatically, and he was discharged on room air. In conclusion, although COVID-19 infection can mimic ANCA-associated vasculitis (AAV), the growing number of case reports along with our report shows the need for awareness of a potential link between COVID-19 infection and AAV which would dramatically change the treatment strategy.
【저자키워드】 COVID-19, SARS-CoV-2, Case report, ANCA-associated vasculitis, pulmonary-renal syndrome, 【초록키워드】 Treatment, coronavirus disease, Severe COVID-19 pneumonia, mechanical ventilation, antibody, Kidney function, Infection, dialysis, kidney, COVID-19 infection, male, Patient, Septic shock, Complication, Vasculitis, chronic kidney failure, association, acute respiratory distress, hemorrhage, steroid, Cyclophosphamide, standard treatment, lesions, syndrome, positive, de novo, complication of COVID-19, alveolar, Administered, IMPROVE, caused, significantly, the patient, cytoplasmic, discharged, presenting, conditions, glomerular,