A novel case of lupus nephritis and mixed connective tissue disorder in a COVID-19 patient

Ali, Sajjad; Almas, Talal; Zaidi, Ujala; Ahmed, Farea; Shaikh, Sufyan; Shaikh, Fathema; Tafveez, Rida; Arsalan, Maaz; Antony, Ishan; Antony, Meetty; Sehar, Burhanuddin; Aborode, Abdullahi Tunde; Ali, Murtaza; Nagarajan, Vikneswaran Raj; Samy, Arjun; Alrawashdeh, Maen Monketh; Alkhattab, Maha; Ramjohn, Joshua; Ramjohn, Jeremy; Huang, Helen; Nawaz, Qassim Shah; Khan, Kashif Ullah; Khullar, Shane

doi:10.1016/j.amsu.2022.103653

Cited by 5 publications

(6 citation statements)

References 47 publications

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“…Colchicine due to the hyperinflammatory state. Caspofungin, piperacillin/tazobactam and doxycycline administered for infection prophylaxis Yes Yes Survived (required ECMO and double lung transplant) Amin et al 2022 [ 27 ] Unknown Unknown Polymyositis No Oral prednisolone 60 mg/day, azathioprine 50 mg twice a day No Yes Survived Ali et al 2022 [ 33 ] Unknown Unknown MCTD associated with a flare of LN Unknown IV methylprednisolone 50 mg once daily throughout hospitalisation, in addition to oral hydroxychloroquine 200 mg once daily No Yes Survived Zamani et al 2021 [ 34 ] Mild 400 mg hydroxychloroquine twice on the first day and 200 mg twice daily for a further 6 days SLE Prednisolone 30 mg daily and hydroxychloroquine, gabapentin, and vitamin B (300 mg daily) No Yes Survived Slimani et al 2021 [ 35 ] Unknown Unknown SLE and aPLS No Nil described Yes No Died Dadras et al 2021 [ 25 ] Unknown Cefazolin (2 g three times daily) and azithromycin (500 mg daily) Dermatomyositis Yes Prednisolone 60 mg daily, methotrexate 15 mg weekly, hydroxychloroquine 400 mg daily Unknown Yes Survived Lokineni et al 2021 [ …”

Section: Resultsmentioning

confidence: 99%

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A systematic review of the incidence, management and prognosis of new-onset autoimmune connective tissue diseases after COVID-19

et al. 2023

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A literature review on new-onset autoimmune connective tissue diseases (ACTDs) following COVID-19 is lacking. We evaluated potential associations between COVID-19 and the development of new-onset ACTDs. The “population” was adults with disease terms for ACTDs, including systemic lupus erythematosus (SLE), Sjogren’s syndrome, systemic sclerosis (SSc), idiopathic inflammatory myositis (IIM), anti-synthetase syndrome, mixed CTD and undifferentiated CTD, and “intervention” as COVID-19 and related terms. Databases were searched for English-language articles published until September 2022. We identified 2236 articles with 28 ultimately included. Of the 28 included patients, 64.3% were female, with a mean age was 51.1 years. The USA reported the most cases (9/28). ACTD diagnoses comprised: 11 (39.3%) IIM (including four dermatomyositis); 7 (25%) SLE; four (14.3%) anti-synthetase syndrome; four (14.3%) SSc; two (7.1%) other ACTD (one lupus/MCTD overlap). Of eight, four (14.3%) patients (including that with lupus/MCTD) had lupus nephritis. The average time from COVID-19 to ACTD diagnosis was 23.7 days. A third of patients were admitted to critical care, one for treatment of haemophagocytic lymphohistiocytosis in SLE (14 sessions of plasmapheresis, rituximab and intravenous corticosteroids) and nine due to COVID-19. 80% of patients went into remission of ACTD following treatment, while three (10%) patients died—one due to macrophage activation syndrome with anti-synthetase syndrome and two from unreported causes. Our results suggest a potential association between COVID-19 and new-onset ACTDs, notably in young females, reflecting more comprehensive CTD epidemiology. The most common diagnosis in our cohort was IIM. The aetiology and mechanisms by which ACTDs emerge following COVID-19 remain unknown and require further research.

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Section: Resultsmentioning

confidence: 99%

“…Seven patients included in our review were diagnosed with SLE, and one with lupus/mixed connective tissue disease (MCTD) overlap [ 30 – 37 ]. Of these eight patients, four presented with lupus nephritis [ 30 , 31 , 33 , 34 ]. Again, a wide age range was noted (22–85 years) with, 75% (6/8) of cases being female.…”

Section: Discussionmentioning

confidence: 99%

A systematic review of the incidence, management and prognosis of new-onset autoimmune connective tissue diseases after COVID-19

et al. 2023

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“…A possible relationship between COVID-19 and rheumatic autoimmune diseases such as SLE has also been recently documented [24][25][26]. However, there is a lack of data and knowledge on MCTD in COVID-19 positive patients [27]. Given these clinical evidences it is interesting to note how rare it is to find the combination of the three AIDs, underlying the connection with a previous Covid-19 infection.…”

Section: Discussionmentioning

confidence: 92%

A rare case of multiple autoimmune syndrome after sars-cov2 infection

Graziade¹,

Nardella²,

Sorrento³

et al. 2022

J Clin Images Med Case Rep

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Mixed Connective Tissue Disease (MCTD) is a complex clinical entity, which includes features of Systemic Lupus Erythematosus (SLE), Rheumatoid Arthritis (RA), Systemic Sclerosis (SSc) and Polymyositis/Dermatomyositis (PM/DM), along with the presence of a distinctive antibody, anti-U1-Ribonucleoprotein (RNP). Autoimmune hepatitis is a chronic inflammatory disease of the liver. It is characterized by increase in transaminase and immunoglobulin G levels, the presence of autoantibodies, and portal inflammatory infiltrate with interface hepatitis at liver biopsy. Primary biliary cholangitis is a chronic inflammatory autoimmune liver disease that is characterized by a positive antimitochondrial antibodies test and consequent progressive destruction of the small intrahepatic bile duct. Many reports have confirmed the development of autoimmune diseases after SARS-CoV-2 infection.Here we report the case of a 64-year-old woman, with a positive medical history for SARS-CoV2 infection, who was admitted to our Internal Medicine Unit “Cesare Frugoni”, Policlinico Hospital, Bari, in January 2022, and diagnosed with an extremely rare Multiple Autoimmune Syndrome (MAS), consisting in Mixed connective tissue disease, autoimmune hepatitisand primary biliary cholangitis.

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“…Table 1 summarizes the clinical characteristics of our two patients together with 10 others in the literature. [21][22][23][24][25][26][27][28][29][30] There were eight women and four men and the mean age at the time of COVID-19 was 39.7 ± 20.1 years (range 18-85). COVID-19 was confirmed by SARS-CoV2 PCR in eight patients and the rapid antigen test (RAT) in one patient.…”

Section: Summary Of Patients Reported In the Literaturementioning

confidence: 99%

“…20 To our knowledge, only a handful of cases of de novo SLE, lupus nephritis or cutaneous lupus in otherwise healthy individuals after SARS-CoV-2 infection have ever been reported in the literature. 4,[21][22][23][24][25][26][27][28][29][30][31] We hereby report two more cases of lupus nephritis which developed for the first time after the viral infection.…”

Section: Introductionmentioning

confidence: 99%

De novo lupus nephritis after SARS-CoV-2 infection

Mok

Chu

Tse

2023

Lupus

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The relationship between viral infection and onset of autoimmune diseases such as systemic lupus erythematosus remains uncertain. During the COVID-19 pandemic, organ-specific and multisystemic autoimmune phenomena temporally related to the viral infection have been described. Immune dysregulation triggered by the SARS-CoV-2 virus leading to hyperactivation of both the innate and adaptive immune systems contributes to the excessive production of pro-inflammatory cytokines, autoantibodies, and subsequent autoimmune manifestations. We report two patients without known autoimmune diseases who developed lupus nephritis shortly after a documented mild SARS-CoV-2 infection. Together with other similar cases in the literature, the observation supports a viral trigger of the development of systemic lupus erythematosus in susceptible individuals.

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A novel case of lupus nephritis and mixed connective tissue disorder in a COVID-19 patient

Cited by 5 publications

References 47 publications

A systematic review of the incidence, management and prognosis of new-onset autoimmune connective tissue diseases after COVID-19

A systematic review of the incidence, management and prognosis of new-onset autoimmune connective tissue diseases after COVID-19

A rare case of multiple autoimmune syndrome after sars-cov2 infection

De novo lupus nephritis after SARS-CoV-2 infection

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