Morris Desiree, Patel Kushal, Rahimi Osman, Sanyurah Omar, Iardino Alfredo, Khan Nazia
Kirk Kerkorian School of Medicine at UNLV, USA.
Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, USA.
Respir Med Case Rep. 2021;34:101549. doi: 10.1016/j.rmcr.2021.101549. Epub 2021 Nov 11.
The SARS-CoV-2 infection has been found to present with different degrees of response and variable levels of inflammation. Patients who have recovered from the initial infection can develop long-term symptomatology. We present a unique case of a middle aged-healthy man who developed complications of ANCA-associated vasculitis after recovering from a mild COVID-19 infection. A previously healthy 53-year-old male presented with hemoptysis and acute renal failure. One month prior, the patient tested positive for COVID-19; not requiring hospitalization. Physical exam findings included bilateral lower extremity petechiae. CT Chest showed bilateral diffuse patchy lung consolidations with cavitary lesions with urinalysis revealing erythrocytes, +1 protein. Hemodialysis and workup for pulmonary-renal syndromes were initiated. Infectious workup results included: negative COVID-19, negative MTB-PCR, respiratory culture revealing yeast. Additional workup revealed; elevated CRP, D-Dimer, and Fibrinogen. Notably, the patient had; decreased C3 and C4 levels; negative Anti-GBM antibody; negative Anti-streptolysin-O; and positive ANCA assay, Proteinase antibody, and mildly positive Myeloperoxidase antibody. Worsening coagulopathy and atrophic kidneys delayed renal biopsy for definitive diagnosis. The patient's respiratory status acutely worsened during hemodialysis with imaging showing markedly increased pulmonary infiltrates. Upon urgent intubation, active frank red bleeding was noted, and the patient sustained 2 cardiac arrests with eventual expiration. Much is to be learned from the Novel SARS-CoV-2 virus and suspected complications. This case highlights a unique complication of COVID-19 leading to a possible AAV and the importance of keeping a broad differential when treating patients who have recovered from the initial infection.
已发现严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染呈现出不同程度的反应和炎症水平变化。从初始感染中康复的患者可能会出现长期症状。我们报告了一例独特病例，一名中年健康男性在从轻度冠状病毒病2019（COVID-19）感染康复后出现抗中性粒细胞胞浆抗体（ANCA）相关血管炎并发症。一名此前健康的53岁男性出现咯血和急性肾衰竭。一个月前，该患者COVID-19检测呈阳性；无需住院治疗。体格检查发现包括双侧下肢瘀点。胸部CT显示双侧弥漫性斑片状肺实变伴空洞性病变，尿液分析显示有红细胞、1+蛋白。开始进行血液透析及肺肾综合征检查。感染性疾病检查结果包括：COVID-19阴性、结核分枝杆菌聚合酶链反应（MTB-PCR）阴性、呼吸道培养发现酵母菌。进一步检查发现；C反应蛋白（CRP）、D-二聚体和纤维蛋白原升高。值得注意的是，该患者；C3和C4水平降低；抗肾小球基底膜（Anti-GBM）抗体阴性；抗链球菌溶血素O阴性；ANCA检测、蛋白酶抗体阳性，髓过氧化物酶抗体弱阳性。凝血功能障碍加重和肾脏萎缩延迟了肾活检以明确诊断。患者在血液透析期间呼吸状况急剧恶化，影像学显示肺部浸润明显增加。紧急插管时，发现有明显的鲜红色活动性出血，患者发生2次心脏骤停，最终死亡。关于新型SARS-CoV-2病毒及其疑似并发症，还有很多需要了解的。本病例突出了COVID-19一种独特的并发症，可能导致ANCA相关血管炎，以及在治疗从初始感染中康复的患者时保持广泛鉴别诊断的重要性。
