Patient with Antineutrophil Cytoplasmic Antibody Associated Small Vessel Vasculitis, Acute Renal Failure, and Coronavirus Disease-19 Pneumonia: A Diagnostic and Therapeutic Challenge

Biljana Gerasimovska-Kitanovska; Gjulshen Selim; Zvezdana Petronijevik; Blagica Pecanova; Gjorgi Stojchev; Natasha Eftimovska-Otovic; Marija Zdravevska; Elena Jovanovska-Janeva; Dubravka Antova; Elena Curakova

doi:10.3889/oamjms.2020.5510

Authors

Biljana Gerasimovska-Kitanovska Department of Internal Medicine, University Clinic of Nephrology, Medical Faculty, Ss. Cyril and Methodius University, Skopje, Republic of Macedonia
Gjulshen Selim Department of Internal Medicine, University Clinic of Nephrology, Medical Faculty, Ss. Cyril and Methodius University, Skopje, Republic of Macedonia
Zvezdana Petronijevik Department of Internal Medicine, University Clinic of Nephrology, Medical Faculty, Ss. Cyril and Methodius University, Skopje, Republic of Macedonia
Blagica Pecanova General Hospital, Strumica, Republic of Macedonia
Gjorgi Stojchev General Hospital, Strumica, Republic of Macedonia
Natasha Eftimovska-Otovic Department of Internal Medicine, General City Hospital, Skopje, Republic of Macedonia
Marija Zdravevska Department of Internal Medicine, University Clinic of Pulmonology and Allergology, Medical Faculty, Ss. Cyril and Methodius University, Skopje, Republic of Macedonia
Elena Jovanovska-Janeva Department of Internal Medicine, University Clinic of Pulmonology and Allergology, Medical Faculty, Ss. Cyril and Methodius University, Skopje, Republic of Macedonia
Dubravka Antova Department of Internal Medicine, University Clinic of Rheumatology, Medical Faculty, Ss. Cyril and Methodius University, Skopje, Republic of Macedonia
Elena Curakova Department of Internal Medicine, University Clinic of Gastroenterohepatology, Medical Faculty, Ss. Cyril and Methodius University, Skopje, Republic of Macedonia

DOI:

https://doi.org/10.3889/oamjms.2020.5510

Keywords:

Antineutrophil cytoplasmic antibody-associated vasculitis, Coronavirus disease-19, Case report

Abstract

BACKGROUND: Antineutrophil cytoplasmatic antibody (ANCA)-associated vasculitis (AAV) has a predilection for the kidney and more than three quarters of patients have renal involvement with rapidly progressive glomerulonephritis. Small-vessel systemic vasculitis may present as pulmonary-renal syndrome and is characterized by necrotizing glomerulonephritis and pulmonary hemorrhage. Diagnosis and therapy for AAV in coronavirus disease (COVID) COVID-19 pandemic require multi-disciplinary collaboration due to the affection of multiple systems and risks associated with immunosuppressive medications.

CASE REPORT: A 69-year-old non-smoker, non-diabetic female presented in the outpatient unit at the department of pulmonology with dry cough, malaise, and sub-febrile temperature, lasting for 1 month. The patient had a high suspicion of severe pulmonary-renal syndrome, ANCA-AAV, and acute renal failure requiring hemodialysis. She was treated with corticosteroids, cyclophosphamide, and plasma exchange. The treatment led to temporary improvement. Infections with COVID-19, Enterococcus in the urine, and Acinetobacter in the tracheal aspirate further complicated the clinical picture and despite antibiotic treatment, use of tocilizumab and convalescent plasma, the outcome was lethal.

CONCLUSION: It is important to establish the diagnosis and distinguish accurately between vasculitis and infection to provide adequate and timely therapy.

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