Assar Shirin, Pournazari Mehran, Soufivand Parviz, Mohamadzadeh Dena, Sanaee Simindokht
Rheumatology Department, Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Egypt Rheumatol. 2021 Jun;43(3):225-228. doi: 10.1016/j.ejr.2021.03.001. Epub 2021 Mar 9.
Microscopic polyangiitis (MPA) is an antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) that affects predominantly small- sized vessels. A causal relationship between viral infections and vasculitis has been postulated.Aim of the workTo present the concomitant association of coronavirus disease 2019 (COVID-19) infection with MPA in an elderly Iranian male.
A 67 year old Iranian man with the history of COVID-19 infection and a positive polymerized chain reaction (PCR) test four weeks before admission to the neurology department with acute onset pain, numbness and progressive weakness in both hands grip, sudden left foot drop and paresthesia. Erythrocyte sedimentation rate (ESR) was 95 mm/hr, ferritin 912 ng/ml and C-reactive protein (CRP) positive, proteinuria 1.1 g/24 h and markedly elevated perinuclear (P-ANCA): 526 IU/ml. Diagnosis of MPA was held presenting with mononeuritis multiplex, glomerulonephritis followed by diffuse alveolar hemorrhage and infiltration of lymphocytes in muscle fibers and vessels wall in sural nerve biopsy. He was successfully treated by methylprednisolone (1 g/day for 3 days) followed by 1 mg/kg with gradual tapering along with cyclophosphamide (CYC) (2 mg/kg). Intravenous immunoglobulin (IVIG, 2 g/kg in four divided doses) started for the management of inflammatory mononeuritis multiplex with gradual improvement. During hospitalization, plasmapheresis was performed due to alveolar hemorrhage for 5 day. The patient returned home on day 32 and followed-up in the rheumatology clinic with improvement of muscle power and handgrip strength.
Vasculitis is potentially one of COVID-19's presenting symptoms and prompt diagnosis and treatment is crucial in improving outcome of patients.
显微镜下多血管炎（MPA）是一种主要累及小血管的抗中性粒细胞胞浆抗体（ANCA）相关性血管炎（AAV）。病毒感染与血管炎之间的因果关系已被提出。
工作目的
介绍一名老年伊朗男性中2019冠状病毒病（COVID-19）感染与MPA的并发关联。
一名67岁的伊朗男性，有COVID-19感染史，入院前四周聚合酶链反应（PCR）检测呈阳性，因双手急性发作疼痛、麻木和进行性无力、突然左足下垂和感觉异常入住神经内科。红细胞沉降率（ESR）为95毫米/小时，铁蛋白912纳克/毫升，C反应蛋白（CRP）呈阳性，蛋白尿1.1克/24小时，核周型（P-ANCA）显著升高：526国际单位/毫升。诊断为MPA，表现为多发性单神经炎、肾小球肾炎，随后出现弥漫性肺泡出血，腓肠神经活检显示肌纤维和血管壁有淋巴细胞浸润。他成功接受了甲泼尼龙治疗（1克/天，共3天），随后以1毫克/千克逐渐减量，同时使用环磷酰胺（CYC）（2毫克/千克）。开始静脉注射免疫球蛋白（IVIG，2克/千克，分四次给药）以治疗炎症性多发性单神经炎，病情逐渐改善。住院期间，因肺泡出血进行了5天的血浆置换。患者于第32天出院，在风湿病诊所随访，肌肉力量和握力有所改善。
血管炎可能是COVID-19的症状之一，及时诊断和治疗对改善患者预后至关重要。
