Diffuse Alveolar Hemorrhage Associated With Severe Acute Respiratory Syndrome Coronavirus 2

Abstract

Diffuse alveolar hemorrhage (DAH) is a rare syndrome resulting from the accumulation of intra-alveolar red blood cells originating most often from the alveolar capillaries and, less frequently, from precapillary arterioles or postcapillary venules. The causes of DAH can be divided into infectious and noninfectious. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus that has not been previously identified in humans, and it is responsible for coronavirus disease-19 (COVID-19) infection.Here, we present a case of DAH that is believed to be a consequence of COVID-19 infection in a female patient with no known past medical history. The patient was found to be positive for perinuclear antineutrophil cytoplasmic antibodies (P-ANCA) and anti-glomerular basement membrane antibodies. The patient was diagnosed with ANCA-associated vasculitis with glomerulonephritis and was treated successfully with methylprednisolone 500 mg intravenous (IV) daily for three days, followed by rituximab 375 mg/m 2 IV once weekly for four weeks. The long-term complications of COVID-19 are not entirely known and are still being investigated. The association between COVID-19 infection and DAH is not fully known. However, the inflammatory process of COVID-19 infection may have a role in vasculitis, leading to DAH.

SARS-CoV-2 Infection: A Forerunner or Precursor in Anti-neutrophil Cytoplasmic Antibody-Associated Vasculitis With Kidney Injury

“…Among the 25 cases, we found in the literature (median age of 49 years with 13 females) (Table 2), AAV was diagnosed one to six months after COVID-19 in 12 patients [11,[16][17][18][19][20][21][22][23][24][25][26] while COVID-19 and AAV were diagnosed during the same admission in 11 cases [5,[27][28][29][30][31][32][33][34][35][36]. It is noteworthy that severe AAV with life-threatening alveolar haemorrhage can follow a mild COVID-19 infection, exemplified by two patients who had mild COVID-19 (managed with self-quarantine but not requiring hospital admission) but subsequently died following pulmonary haemorrhage [12,21].…”

“…Among the 25 cases, we found in the literature (median age of 49 years with 13 females) (Table 2 ), AAV was diagnosed one to six months after COVID-19 in 12 patients [ 11 , 16 - 26 ] while COVID-19 and AAV were diagnosed during the same admission in 11 cases [ 5 , 27 - 36 ].…”

Antineutrophil Cytoplasmic Autoantibody (ANCA)-Associated Vasculitis With Mucosal Involvement Following COVID-19 Pneumonia

“…Our case involves a previously healthy male who developed AAV that was likely triggered by post-COVID-19 hyperinflammatory syndrome as suggested by the continuously elevated ferritin and triglycerides. Only a few case reports in the literature have described the incidence of AAV following COVID-19 infection, and none of the reported cases share similar cutaneous manifestations of AAV in the form of hemorrhagic bullae as in our patient [5][6][7][8][9][10][11][12][13]. In addition, none of the reported cases had oral mucosal involvement.…”