Thabet N1*, Aicha NB1, Mahfoudh O1, Mrabet S1, Abdessaied NB2, Azzabi A1, Sahtout W1, Boukadia R1, Fradi A1, Guedri Y1, Zellama D1 and Achour A1
1Department of Nephrology, Sahloul University Hospital, Tunisia
2Department of Anatomopathology, Farhat Hached University Hospital, Tunisia
Anti-Neutrophil Cytoplasmic Autoantibody (ANCA) -Associated Vasculitis (AAV) is an autoimmune disorder characterized by inflammation and damage to small blood vessels. It’s a systemic disease affecting several organs. Rare cases of AAV following SARS-CoV-2 infections were published. We report in this article a Myeloperoxidase Anti-Neutrophil Cytoplasmic Antibody (MPO-ANCA) associated vasculitis following COVID-19 infection. It is about A-54-year-old women, with a history of type 2 diabetes and hypertension. She was vaccinated against COVID-19 with an RNA vaccine, a single dose on June 2021. On July 2021, she had COVID-19 pneumonia with 97 μmol/l serum creatinine level. Afterwards the patient presented with deterioration in her general condition with prolonged fever. The biological analyzes showed a severe acute renal injury with 606 μmol/l serum creatinine level, anemia (hemoglobin = 6 g/dl), absence of leukocyte or red blood cells on Cytobacteriological Examination of Urine (CBEU), 24 h proteinuria was 0.7 g/24 h with a diuresis of 1500 ml/24 h. She was thus admitted to the nephrology department. Ten days later, the patient's renal function worsened even more with creatinine reaching 1011 μmol/l but still without hematuria on CBEU. Immunological investigations and renal biopsy was performed. MPO ANCA was positive and the renal biopsy showed severe glomerular and tubulointerstitial damages. The glomeruli contained extracapillary proliferation. Necrotic cells were observed within tubes lumen. Edematous changes associated with an abundant and acute inflammatory infiltrate within the interstitium were found. The patient had an intra-alveolar hemorrhage confirmed by the chest CT scan with respiratory distress and recourse to mechanical ventilation. She had IV methylprednisolone followed by prednisone 1 mg/kg/d, 6 boli of cyclophosphamide and 7 plasmapheresis sessions as induction therapy. The evolution was marked by clinical and biological improvement with a creatinine at 120 μmol/l. To conclude, diagnosis and management of ANCA related vasculitis is a big challenge for medical practitioners. VAA can be associated to COVID-19. In fact, SARS-CoV-2 can be a trigger factor for the VAA.
Thabet N, Aicha NB, Mahfoudh O, Mrabet S, Abdessaied NB, Azzabi A, et al. Case Report: Myeloperoxidase Anti- Neutrophil Cytoplasmic Antibody (MPOANCA) Associated Vasculitis Following Coronavirus Disease (COVID-19). Ann Clin Case Rep. 2022; 7: 2265.