Division of Rheumatology, Department of Internal Medicine, Ondokuz Mayıs University Medical Faculty, Korfez Mahallesi, 55270, Atakum/Samsun, Turkey.
Division of Nephrology, Department of Internal Medicine, Ondokuz Mayıs University Medical Faculty, Korfez Mahallesi, 55270, Atakum/Samsun, Turkey.
Rheumatol Int. 2021 Aug;41(8):1523-1529. doi: 10.1007/s00296-021-04914-3. Epub 2021 Jun 7.
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.
抗中性粒细胞胞质抗体（ANCA）相关性血管炎（AAV）是一种系统性自身免疫性疾病，由于单核细胞浸润和中小血管破坏，可能导致肾衰竭。已经表明，严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）可能引发自身免疫性疾病的表现或恶化。冠状病毒病 2019（COVID-19）患者新月体性肾小球肾炎（GN）很少见。我们报告了最近诊断为 COVID-19 后出现 AAV 的两例罕见病例。第一例是 26 岁男性患者，COVID-19 后出现急性肾损伤。血清肌酐升高，尿沉渣活跃。血清学评估显示抗髓过氧化物酶抗体水平为 80.6 U/mL。肾活检显示伴有细胞性新月体的坏死性 GN。给予甲基强的松龙、环磷酰胺和血浆置换。他在血液透析后出院。第二例是一位 36 岁女性，因发热、咳嗽和呼吸困难住院。她被诊断为 COVID-19 后，出现双侧肺实质空洞病变和全聋以及急性肾损伤。血清学评估显示蛋白酶 3 升高，水平为 1:32。肾活检显示伴有细胞性新月体的坏死性 GN。甲基强的松龙和环磷酰胺治疗后肾功能改善。通过对文献的系统回顾，我们发现了 4 例因 COVID-19 导致的新发 AAV。在此，我们讨论了两例病例，并对 COVID-19 感染后新发寡免疫性 GN 病例进行了文献复习。
