New‐onset ANCA‐associated vasculitis presenting with neuropathy after COVID‐19 infection: A case report and literature review

Abstract

Key Clinical MessageCoronavirus Disease 2019 (COVID‐19) is a viral infection caused by SARS‐CoV‐2, which can trigger autoimmune diseases such as antineutrophilic cytoplasmic antibody (ANCA) associated vasculitis (AAV) that affect small and medium‐sized blood vessels in multiple organs. This study discusses a case with neuropathy and positive ANCA after COVID‐19 infection and reviews the literature on AAV following COVID‐19 infection. A 59‐year‐old man is presented that was referred to Shariati Hospital for evaluation of neurologic problems after a COVID‐19 infection. Initially, he had flu‐like symptoms. A few days later, he developed right distal upper and lower limb paresthesia. His electromyography (EMG) and nerve conduction velocity (NCV) results were consistent with polyneuropathy. Lumbar puncture (LP) was normal except for positive COVID‐19 polymerase chain reaction (PCR). The patient's paresthesia worsened. Laboratory data showed leukocytosis, anemia, thrombocytosis, high erythrocyte sedimentation rate (ESR), and C‐reactive protein (CRP). Perinuclear anti‐neutrophil cytoplasmic antibody (MPO‐ANCA) was positive. According to the results, vasculitis was the main differential diagnosis. The sural nerve biopsy was performed, and the result was consistent with small to medium‐sized vessel vasculitis. The patient was diagnosed with COVID‐induced AAV. He was prescribed methylprednisolone and cyclophosphamide and was discharged with prednisolone and cotrimoxazole. In this study, a unique case of AAV induced by COVID‐19 infection confirmed by nerve biopsy is presented. A review of the literature found 48 cases of new‐onset AAV in adults and pediatrics after COVID‐19 infection. Further research is needed to completely understand the relationship between COVID‐19.

Acute Respiratory Failure in Autoimmune Rheumatic Diseases: A Review

“…The advent of COVID-19, arising from the novel coronavirus SARS-CoV-2, presents formidable challenges for individuals with autoimmune rheumatic diseases, predisposing them to heightened risks of complications such as acute respiratory failure. Autoimmune rheumatic conditions, encompassing disorders like rheumatoid arthritis, lupus, and vasculitis, are characterized by an aberrant immune response, often resulting in inflammatory processes and organ damage, particularly affecting pulmonary function [68,69]. When compounded with the respiratory distress precipitated by COVID-19, the susceptibility to acute respiratory failure escalates [70,71].…”

“…The progression towards a severe clinical presentation is underscored by the intricate phenomenon termed a "cytokine storm", activated by conceivable immunological mechanisms triggered by the viral incursion [71,72]. Perturbations in immune modulation, alongside potential autoinflammatory and autoimmune cascades, engender an exacerbated release of cytokines from immune cells, thereby exacerbating the inflammatory milieu [69,73]. Comprehensive management strategies necessitate vigilant monitoring, early symptom detection, and a collaborative approach involving rheumatologists and pulmonologists to optimize therapeutic interventions and mitigate the risk of severe respiratory sequelae.…”