Antineutrophil Cytoplasmic Antibody (ANCA)-Associated Renal Vasculitis After COVID-19 Infection: A Case Report

Kataria, Saurabh; Rogers, Sylvette; Sadia, Haleema; Ali, Tooba; Qureshi, Hasham M; Bano, Shehar; Anigbo, Chinyere L; Singh, Romil

doi:10.7759/cureus.26111

Cited by 6 publications

(6 citation statements)

References 13 publications

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“…The incidence of ANCA-associated vasculitis was increased in individuals with COVID-19, which was consistent with previous reports. 48 , 49 , 50 Plausible mechanisms involve viral-induced hypercoagulability resulting from endothelial infection or injury, complement system activation, and dysregulation of the coagulation cascade, ultimately leading to vasculopathy. 51 , 52 Moreover, the protracted exposure of neutrophil extracellular traps has been postulated to elicit the development of antineutrophil antibodies.…”

Section: Discussionmentioning

confidence: 99%

Autoimmune and Autoinflammatory Connective Tissue Disorders Following COVID-19

Lim,

Ju,

Han

et al. 2023

JAMA Netw Open

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ImportanceMultiple cases of autoimmune and autoinflammatory diseases after COVID-19 have been reported. However, their incidences and risks have rarely been quantified.ObjectiveTo investigate the incidences and risks of autoimmune and autoinflammatory connective tissue disorders after COVID-19.Design, Setting, and ParticipantsThis was a retrospective population-based study conducted between October 8, 2020, and December 31, 2021, that used nationwide data from the Korea Disease Control and Prevention Agency COVID-19 National Health Insurance Service cohort and included individuals who received a diagnosis of COVID-19 via polymerase chain reaction testing and a control group with no evidence of COVID-19 identified from National Health Insurance Service of Korea cohort. Data analysis was conducted from September 2022 to August 2023.ExposuresReceipt of diagnosis of COVID-19.Main Outcomes and MeasuresThe primary outcomes were the incidence and risk of autoimmune and autoinflammatory connective tissue disorders following COVID-19. A total of 32 covariates, including demographics, socioeconomic statuses, lifestyle factors, and comorbidity profiles, were balanced through inverse probability weighting. The incidences and risks of autoimmune and autoinflammatory connective tissue disorders were compared between the groups using multivariable Cox proportional hazard analyses.ResultsA total of 354 527 individuals with COVID-19 (mean [SD] age, 52.24 [15.55] years; 179 041 women [50.50%]) and 6 134 940 controls (mean [SD] age, 52.05 [15.63] years; 3 074 573 women [50.12%]) were included. The risks of alopecia areata (adjusted hazard ratio [aHR], 1.12; 95% CI, 1.05-1.19), alopecia totalis (aHR, 1.74; 95% CI, 1.39-2.17), antineutrophil cytoplasmic antibody–associated vasculitis (aHR, 2.76; 95% CI, 1.64-4.65), Crohn disease (aHR, 1.68; 95% CI, 1.31-2.15), and sarcoidosis (aHR, 1.59; 95% CI, 1.00-2.52) were higher in the COVID-19 group. The risks of alopecia totalis, psoriasis, vitiligo, vasculitis, Crohn disease, ulcerative colitis, rheumatoid arthritis, adult-onset Still disease, Sjögren syndrome, ankylosing spondylitis, and sarcoidosis were associated with the severity of COVID-19.Conclusions and RelevanceIn this retrospective cohort study, COVID-19 was associated with a substantial risk for autoimmune and autoinflammatory connective tissue disorders, indicating that long-term management of patients with COVID-19 should include evaluation for such disorders.

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Section: Discussionmentioning

confidence: 99%

Autoimmune and Autoinflammatory Connective Tissue Disorders Following COVID-19

Lim,

Ju,

Han

et al. 2023

JAMA Netw Open

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“…In our literature review, we found eight cases of newonset AAV temporally associated with COVID-19 in adults (Table 1). 2,[8][9][10][11][12] After inclusion of the present case, out of the nine patients, five (55%) were female and the mean age was 49.77 years. One (11%) patient had scleroderma, and one (11%) patient had rheumatoid arthritis.…”

Section: Discussionmentioning

confidence: 99%

New-onset microscopic polyangiitis temporally associated with severe COVID-19 infection: A case report

Meade-Aguilar,

Varela-Martinez,

Ramirez-Eguía

et al. 2023

SAGE Open Medical Case Reports

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The coronavirus disease 2019 has been demonstrated to be a trigger for multiple immune-mediated diseases, such as antineutrophil cytoplasmic antibody-associated vasculitis. Associated vasculitis consists of rare autoimmune disorders that predominantly affect small vessels, leading to endothelial injury and tissue damage. We present a case of a newly diagnosed microscopic polyangiitis temporally associated with coronavirus disease 2019 infection in a previously healthy woman and a literature review. A 66-year-old female presented to the Emergency Room with fever, edema on her legs, productive cough, dyspnea, and hemoptysis. A chest computerized tomography scan revealed bilateral diffuse alveolar opacities with the appearance of diffuse alveolar hemorrhage. Blood analysis revealed a moderate normocytic, normochromic anemia with a hemoglobin of 6.6 g/dL, platelet count of 347 k/dL, leucocytes of 12,000/dL, a creatinine of 3.91 mg/dL (basal Cr: 0.9 mg/dL), and a Blood Urine Nnitrogen of 78 mg/dL. A urine sediment demonstrated glomerular hematuria, with mixed shapes of red blood cells. She was admitted to the intensive care unit and a bedside bronchoscopy revealed progressive bleeding with a bronchioalveolar lavage positive for diffuse alveolar hemorrhage. Given the critical involvement of the lungs and kidney function, the diagnostic approach revealed a positive p-anti-neutrophil cytoplasmic antibody on immunofluorescence and an anti-MPO (myeloperoxidase) level of 124.6 IU/mL. A renal biopsy demonstrated pauciimmune focal and segmental glomerulosclerosis. A diagnosis of microscopic polyangiitis triggered by severe acute respiratory syndrome coronavirus 2 infection was made, and immediate treatment with pulse-dose steroids and cyclophosphamide was initiated. The patient needed renal replacement therapy and was discharged for follow-up with nephrology and rheumatology services. The diagnostic approach of associated vasculitis can be more challenging in the coronavirus disease era. Atypical features in the pulmonary imaging and a rapid deterioration of the renal function should arise the clinical suspicion of the presence of an added condition to the coronavirus disease infection. Autoimmune conditions such as associated vasculitis should be evaluated even in the absence of previous autoimmune history. Prompt diagnosis and treatments must be prioritized to avoid end-organ definite damage. Further, larger and more collaborative studies are needed to confirm the potential role of coronavirus disease 2019 as a trigger of associated vasculitis.

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“…The authors note that COVID-19 and AAVs are multisystem diseases. A causal relationship is believed to exist between the two conditions, and this is supported by clinical case reports [12,22,25,27,29,35,39]. Moreover, the symptoms of COVID-19 can mimic those of vasculitis, especially if the respiratory system is affected.…”

Section: Presentation Of Clinical Cases Casementioning

confidence: 91%

“…Today, there is more and more evidence that SARS-CoV-2 is another virus that can lead to disruption of the regulation of the immune system and provoke the appearance or exacerbate already existing autoimmune diseases in children and adults [24][25][26][31][32][33][34][35], especially in genetically predisposed individuals [12,32,35]. Moreover, numerous new autoimmune diseases in adults have been described in the literature as post-infectious complication of COVID-19 infection [25].…”

Section: Presentation Of Clinical Cases Casementioning

confidence: 99%

Microscopic polyangiitis hiding behind the mask of COVID-19: A case series and minireview

Yarmola¹,

Gutsalenko²,

Katerenchuk³

et al. 2023

Ukr. J. Nephrol. and Dial.

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Microscopic polyangiitis (MPA) is one of the three clinical phenotypes of vasculitis associated with antineutrophil cytoplasmic antibodies (ANCA). Although MPA is considered a rare form of ANCA-associated vasculitis (AAV), clinical evidence shows that it is fairly common among nephrologists, as it manifests as a systemic, weak-immune vasculitis affecting glomerular capillaries, resulting in necrotizing glomerulonephritis (GN) diagnosed in nearly 100% of MPA patients. The issue of AAV in general, and MPA specifically, has gained significant importance in the context of the ongoing SARS-CoV-2 coronavirus pandemic, as both conditions share common anatomical sites of infection and inflammation. This study presents three new cases of MPA in post-COVID-19 patients. The analysis and presentation encompassed demographic data, patient history regarding comorbidities, details of follow-up care, chronology with COVID-19, and laboratory findings at the time of MPA diagnosis. A comparative analysis of the chronological progression of MPA in the documented clinical cases reveals the polymorphic nature of early-stage clinical manifestations, as well as diverse patterns of disease progression in the advanced stage. Additionally, we provide a brief literature review on diagnostic challenges, pathogenetic mechanisms underlying the relationship between SARS-CoV-2 and AAV, and peculiarities of clinical presentations in early and advanced stages of MPA.

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Antineutrophil Cytoplasmic Antibody (ANCA)-Associated Renal Vasculitis After COVID-19 Infection: A Case Report

Cited by 6 publications

References 13 publications

Autoimmune and Autoinflammatory Connective Tissue Disorders Following COVID-19

Autoimmune and Autoinflammatory Connective Tissue Disorders Following COVID-19

New-onset microscopic polyangiitis temporally associated with severe COVID-19 infection: A case report

Microscopic polyangiitis hiding behind the mask of COVID-19: A case series and minireview

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