Eosinophilic granulomatosis with polyangiitis mimicking coronavirus disease 2019: a case report

Hashizume, Hideo; Sano, Yusuke; Furukawa, Soma; Imokawa, Shiro

doi:10.1111/jdv.16705

Cited by 11 publications

(7 citation statements)

References 12 publications

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“…During the COVID-19 pandemic, the diagnosis and treatment of AAV have been discussed in many ways. AAV can mimic COVID-19 in terms of pulmonary involvement, COVID-19 may occur simultaneously with AAV, and COVID-19 can cause AAV-like symptoms [ 20 – 23 ]. Therefore, it has forced the clinicians to be more careful.…”

Section: Discussionmentioning

confidence: 99%

ANCA-associated vasculitis after COVID-19

et al. 2021

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Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) are systemic autoimmune diseases that may lead to renal failure due to the infiltration of mononuclear cells and the destruction of small- and medium-sized blood vessels. It has been shown that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may trigger the presentation or exacerbation of autoimmune diseases. Crescentic glomerulonephritis (GN) has rarely been reported in patients with Coronavirus disease-2019 (COVID-19). We present rare two cases with AAV after a recent diagnosis of COVID-19. The first case was 26-year-old male patient, who was presented with acute kidney injury after COVID-19. Serum creatinine increased and active urine sediment was seen. Serological evaluation showed anti-myeloperoxidase antibody was at a level of 80.6 U/mL. Kidney biopsy showed necrotizing GN with cellular crescents. Methylprednisolone, cyclophosphamide and plasma exchange were administered. He was discharged with hemodialysis. Second case was a 36-year-old female who was hospitalized because of fever, cough and dyspnea. After she was diagnosed with COVID-19, she had total hearing loss, with cavitary lesions on bilateral lung parenchyma and an acute kidney injury. Serological evaluation showed an elevated anti-proteinase-3 with a level of 1:32. Kidney biopsy showed necrotizing GN with cellular crescents. Renal function improved after methylprednisolone and cyclophosphamide treatment. With a systematic review of the literature, we found four cases of new-onset AAV due to COVID-19. Herein, we discuss two cases and provide a literature review on cases of new-onset pauci-immune GN after COVID-19 infection.

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Section: Discussionmentioning

confidence: 99%

ANCA-associated vasculitis after COVID-19

et al. 2021

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“…Likewise, Craver et al [ 107 ] documented the case of a previously healthy 17-year-old male who presented in cardiac arrest and was diagnosed post-mortem with fatal eosinophilic myocarditis associated with a positive nucleic acid test for SARS-CoV-2. Finally, two case reports documented clinical findings of three patients who presented with eosinophilic granulomatosis, with polyangiitis, and with signs and symptoms that largely mimicked those of acute SARS-CoV-2 infection [ 108 , 109 ]. Collectively, the findings presented in these case studies suggest that clinicians should be on high alert for eosinophil-associated findings and complications associated with COVID-19.…”

Section: Covid-19 In Patients With Eosinophil-associated Diseases Andmentioning

confidence: 99%

Eosinophils and COVID-19: diagnosis, prognosis, and vaccination strategies

Rosenberg

Foster

2021

Semin Immunopathol

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The unprecedented impact of the coronavirus disease 2019 (COVID-19) pandemic has resulted in global challenges to our health-care systems and our economic security. As such, there has been significant research into all aspects of the disease, including diagnostic biomarkers, associated risk factors, and strategies that might be used for its treatment and prevention. Toward this end, eosinopenia has been identified as one of many factors that might facilitate the diagnosis and prognosis of severe COVID-19. However, this finding is neither definitive nor pathognomonic for COVID-19. While eosinophil-associated conditions have been misdiagnosed as COVID-19 and others are among its reported complications, patients with pre-existing eosinophil-associated disorders (e.g., asthma, eosinophilic gastrointestinal disorders) do not appear to be at increased risk for severe disease; interestingly, several recent studies suggest that a diagnosis of asthma may be associated with some degree of protection. Finally, although vaccine-associated aberrant inflammatory responses, including eosinophil accumulation in the respiratory tract, were observed in preclinical immunization studies targeting the related SARS-CoV and MERS-CoV pathogens, no similar complications have been reported clinically in response to the widespread dissemination of either of the two encapsulated mRNA-based vaccines for COVID-19.

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“…All of the patients were observed to present with respiratory symptoms and COVID-19 was the preliminary diagnosis in all. GGO were present in all cases, however, none of them was PCR positive which was probably the main reason for consideration of other conditions [12][13][14]. Six of these cases had peripheral eosinophilia as a common feature contradictory to the fact that eosinopenia is more common in COVID-19, reaching a rate of 95% in some studies [15][16][17][18].…”

Section: Discussionmentioning

confidence: 83%

COVID-19 and eosinophilic granulomatosis with polyangiitis or COVID-19 mimicking eosinophilic granulomatosis with polyangiitis?

et al. 2021

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Coronavirus disease 2019 (COVID-19) and eosinophilic granulomatosis with polyangiitis (EGPA) share similarities in clinical, imaging findings and may present with respiratory distress. Differentiating a new-onset EGPA from COVID-19 during the current pandemic is a diagnostic challenge, particularly if other EGPA symptoms are overlooked. Here in this study we reviewed the literature regarding EGPA patients with COVID-19 and patients who diagnosed with EGPA or suffered an EGPA flare mimicking COVID-19. We conducted a literature survey in PUBMED database using meshed keywords "COVID-19" and "EGPA", "COVID-19" and "eosinophilic granulomatosis with polyangiitis", "COVID-19" and "Churg Strauss Syndrome", to reveal previously reported cases involving EGPA patients who had COVID-19 infection, patients who suspected to have COVID-19 but eventually diagnosed with EGPA and patients with a known diagnosis of EGPA who suffered a flare but a COVID-19 infection was suspected initially. A total of 11 cases (6 literature cases, 5 cases from our clinic) were included in our study. Seven (63.6%) of the cases were defined as COVID-19 mimicker and 4 (36.4%) were EGPA with COVID-19. All of the cases in EGPA with COVID-19 group had a history of asthma. All of them had a positive PCR result and ground-glass opacities in thorax CT. In COVID-19 mimicker group, six (85.7%) patients had a history of asthma and other EGPA features that were observed were eosinophilia in 6 (85.7%). Our study provided clues regarding the EGPA/ COVID-19 diagnostic challenge which may be useful in the current pandemic. Since none of the findings in COVID-19 are disease-specific, other conditions like EGPA should not be overlooked particularly in PCR negative patients and clinical, laboratory and imaging findings should be interpreted carefully. Furthermore, we did not observe poor outcomes in EGPA patients who had COVID-19.

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Eosinophilic granulomatosis with polyangiitis mimicking coronavirus disease 2019: a case report

Cited by 11 publications

References 12 publications

ANCA-associated vasculitis after COVID-19

ANCA-associated vasculitis after COVID-19

Eosinophils and COVID-19: diagnosis, prognosis, and vaccination strategies

COVID-19 and eosinophilic granulomatosis with polyangiitis or COVID-19 mimicking eosinophilic granulomatosis with polyangiitis?

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