Multi-Organ Relapse following COVID-19 in Myeloperoxidase-Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis: A Case Report
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a complex systemic autoimmune disease characterized by small vessel vasculitis. Typically, the relapse rate is lower in patients with end-stage kidney disease (ESKD) than in those with chronic kidney disease, prior to dialysi...
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| Format: | Article |
| Language: | English |
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Karger Publishers
2023-10-01
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| Series: | Case Reports in Nephrology and Dialysis |
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| Online Access: | https://beta.karger.com/Article/FullText/534331 |
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| author | Won-Hee Cho Seo Yeon Hwang Sun Ryoung Choi Biro Kim Joune Seoup Lee Dong Gun Lee Hyun Soon Lee |
| author_facet | Won-Hee Cho Seo Yeon Hwang Sun Ryoung Choi Biro Kim Joune Seoup Lee Dong Gun Lee Hyun Soon Lee |
| author_sort | Won-Hee Cho |
| collection | DOAJ |
| description | Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a complex systemic autoimmune disease characterized by small vessel vasculitis. Typically, the relapse rate is lower in patients with end-stage kidney disease (ESKD) than in those with chronic kidney disease, prior to dialysis. Here, we report a rare case of multi-organ relapse in a patient with myeloperoxidase (MPO)-AAV who underwent hemodialysis following coronavirus disease 2019 (COVID-19). A man in his 70s with type 2 diabetes and hypertension was undergoing maintenance hemodialysis for ESKD resulting from MPO-AAV glomerulonephritis. Following severe acute respiratory syndrome coronavirus 2 infection, the patient was hospitalized for persistent nausea and vomiting. No significant findings were observed, including in endoscopy. However, the patient experienced severe symptoms that hindered oral intake and was refractory to pharmacological therapy. Additionally, despite receiving antibiotics and antituberculosis treatment, the patient experienced persistent unexplained pleural effusion. Moreover, the patient’s level of consciousness rapidly deteriorated during hospitalization. Although C-reactive protein levels and MPO-ANCA titers were elevated, no evidence of infection was detected on brain imaging or cerebrospinal fluid analysis. Therefore, we diagnosed this case as a relapse of AAV and promptly administered methylprednisolone pulse therapy and rituximab. Subsequently, all aforementioned symptoms in the patient improved, and the current ANCA levels remain negative. Thus, the relapse of AAV after COVID-19 is rare; however, it can present in several ways in patients undergoing dialysis. Therefore, clinicians should closely monitor ANCA titers and subtle symptoms, even in patients with dialysis-dependent AAV. |
| first_indexed | 2024-03-10T04:26:37Z |
| format | Article |
| id | doaj.art-3ca9179e5547494db9081111cd76333a |
| institution | Directory Open Access Journal |
| issn | 2296-9705 |
| language | English |
| last_indexed | 2024-03-10T04:26:37Z |
| publishDate | 2023-10-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Case Reports in Nephrology and Dialysis |
| spelling | doaj.art-3ca9179e5547494db9081111cd76333a2023-11-23T07:16:29ZengKarger PublishersCase Reports in Nephrology and Dialysis2296-97052023-10-0113117318310.1159/000534331534331Multi-Organ Relapse following COVID-19 in Myeloperoxidase-Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis: A Case ReportWon-Hee Cho0Seo Yeon Hwang1Sun Ryoung Choi2Biro Kim3Joune Seoup Lee4Dong Gun Lee5Hyun Soon Lee6Division of Nephrology, Department of Internal Medicine, Sahmyook Medical Center, Seoul, Republic of KoreaDepartment of Internal Medicine, Sahmyook Medical Center, Seoul, Republic of KoreaDivision of Nephrology, Department of Internal Medicine, Sahmyook Medical Center, Seoul, Republic of KoreaDivision of Nephrology, Department of Internal Medicine, Sahmyook Medical Center, Seoul, Republic of KoreaDivision of Gastroenterology, Department of Internal Medicine, Sahmyook Medical Center, Seoul, Republic of KoreaDepartment of Neurology, Sahmyook Medical Center, Seoul, Republic of KoreaHankook Renal Pathology Lab., Seoul, Republic of KoreaAnti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a complex systemic autoimmune disease characterized by small vessel vasculitis. Typically, the relapse rate is lower in patients with end-stage kidney disease (ESKD) than in those with chronic kidney disease, prior to dialysis. Here, we report a rare case of multi-organ relapse in a patient with myeloperoxidase (MPO)-AAV who underwent hemodialysis following coronavirus disease 2019 (COVID-19). A man in his 70s with type 2 diabetes and hypertension was undergoing maintenance hemodialysis for ESKD resulting from MPO-AAV glomerulonephritis. Following severe acute respiratory syndrome coronavirus 2 infection, the patient was hospitalized for persistent nausea and vomiting. No significant findings were observed, including in endoscopy. However, the patient experienced severe symptoms that hindered oral intake and was refractory to pharmacological therapy. Additionally, despite receiving antibiotics and antituberculosis treatment, the patient experienced persistent unexplained pleural effusion. Moreover, the patient’s level of consciousness rapidly deteriorated during hospitalization. Although C-reactive protein levels and MPO-ANCA titers were elevated, no evidence of infection was detected on brain imaging or cerebrospinal fluid analysis. Therefore, we diagnosed this case as a relapse of AAV and promptly administered methylprednisolone pulse therapy and rituximab. Subsequently, all aforementioned symptoms in the patient improved, and the current ANCA levels remain negative. Thus, the relapse of AAV after COVID-19 is rare; however, it can present in several ways in patients undergoing dialysis. Therefore, clinicians should closely monitor ANCA titers and subtle symptoms, even in patients with dialysis-dependent AAV.https://beta.karger.com/Article/FullText/534331anti-neutrophil cytoplasmic antibody vasculitiscovid-19multi-organ relapsedialysisend-stage kidney disease |
| spellingShingle | Won-Hee Cho Seo Yeon Hwang Sun Ryoung Choi Biro Kim Joune Seoup Lee Dong Gun Lee Hyun Soon Lee Multi-Organ Relapse following COVID-19 in Myeloperoxidase-Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis: A Case Report Case Reports in Nephrology and Dialysis anti-neutrophil cytoplasmic antibody vasculitis covid-19 multi-organ relapse dialysis end-stage kidney disease |
| title | Multi-Organ Relapse following COVID-19 in Myeloperoxidase-Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis: A Case Report |
| title_full | Multi-Organ Relapse following COVID-19 in Myeloperoxidase-Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis: A Case Report |
| title_fullStr | Multi-Organ Relapse following COVID-19 in Myeloperoxidase-Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis: A Case Report |
| title_full_unstemmed | Multi-Organ Relapse following COVID-19 in Myeloperoxidase-Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis: A Case Report |
| title_short | Multi-Organ Relapse following COVID-19 in Myeloperoxidase-Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis: A Case Report |
| title_sort | multi organ relapse following covid 19 in myeloperoxidase anti neutrophil cytoplasmic antibody associated vasculitis a case report |
| topic | anti-neutrophil cytoplasmic antibody vasculitis covid-19 multi-organ relapse dialysis end-stage kidney disease |
| url | https://beta.karger.com/Article/FullText/534331 |
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