Department of General Internal Medicine, Yodogawa Christian Hospital, 1-7-50 Kunijima, Higashiyodogawa, Osaka, Japan.
Department of Rheumatology, Yodogawa Christian Hospital, Osaka, Japan.
J Med Case Rep. 2023 Aug 26;17(1):366. doi: 10.1186/s13256-023-04081-y.
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis is a systemic autoimmune disease characterized by mononuclear cell infiltration and small and medium-sized blood vessel destruction leading to renal failure. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been shown to have the potential to induce the presentation or exacerbation of autoimmune disease. This report describes the clinical features of a case of newly diagnosed ANCA-associated vasculitis after COVID-19 Infection.
During the COVID-19 pandemic, a 67- year-old female Japanese was undergoing treatment for interstitial pneumonia, diabetes mellitus, and hypertension at her local doctor. About 2 months ago, she was diagnosed with COVID-19 and went to a hotel for treatment, and her condition improved. But a month later, after her COVID-19 infection, she presented with a fever and cough and visited Yodogawa Christian Hospital in Osaka, Japan. The reverse transcription-polymerase chain reaction was negative. She underwent extensive radiological and laboratory investigations. Serologies revealed a high perinuclear-ANCA titer with a specific anti-myeloperoxidase antibody titer of 31.7 units/mL. We suspected ANCA-associated vasculitis and performed a renal biopsy. Renal biopsy showed evidence of crescentic glomerulonephritis, which was consistent with ANCA-associated vasculitis. The patient was referred to the Department of Rheumatology and Clinical Immunology for steroid pulse and cyclophosphamide treatment.
Delayed screening may lead to progression of the autoimmune disease, so prompt diagnosis is necessary. In this case, we could make an immediate diagnosis and refer the patient to the Department of Rheumatology and Clinical Immunology.
抗中性粒细胞胞浆抗体（ANCA）相关性血管炎是一种系统性自身免疫性疾病，其特征为单核细胞浸润和中小血管破坏，导致肾衰竭。严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）已被证明有诱发自身免疫性疾病表现或恶化的潜力。本报告描述了一例 COVID-19 感染后新发 ANCA 相关性血管炎的临床特征。
在 COVID-19 大流行期间，一位 67 岁的日本女性在当地医生处接受间质性肺炎、糖尿病和高血压的治疗。大约 2 个月前，她被诊断患有 COVID-19 并前往一家酒店接受治疗，病情有所改善。但一个月后，在 COVID-19 感染后，她出现发热和咳嗽，并前往日本大阪的淀川基督教医院就诊。逆转录-聚合酶链反应为阴性。她接受了广泛的影像学和实验室检查。血清学检查显示核周型 ANCA 滴度高，特异性髓过氧化物酶抗体滴度为 31.7 单位/mL。我们怀疑为 ANCA 相关性血管炎，并进行了肾活检。肾活检显示新月体性肾小球肾炎的证据，符合 ANCA 相关性血管炎。患者被转至风湿免疫科进行类固醇脉冲和环磷酰胺治疗。
延迟筛查可能导致自身免疫性疾病的进展，因此需要及时诊断。在本例中，我们能够立即做出诊断，并将患者转至风湿免疫科。
