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Kidney Week

Abstract: PO0810

Diagnosing Vasculitis in the Era of COVID-19: A Diagnostic Dilemma for House Staff Officers

Session Information

Category: Trainee Case Report

  • Coronavirus (COVID-19)

Authors

  • Avva, Kalyani Lakshmi, Methodist Health System, Dallas, Texas, United States
  • Collazo-Maldonado, Roberto L., Methodist Health System, Dallas, Texas, United States
  • Farmakis, Christopher, Methodist Health System, Dallas, Texas, United States
Introduction

During our current pandemic, physicians must exclude COVID-19 in every patient presenting to the
hospital with a febrile illness. However, every patient should have a complete work-up done to not miss
other disease processes. Here we describe a case of microscopic polyangiitis with symptoms mimicking
COVID-19.

Case Description

The patient is a 69 yo female with history of HTN who presented with four weeks of polyarthralgia and
fevers; this was accompanied by a dry cough and morning stiffness in her shoulders and hips, for which
she heavily used ibuprofen. Vital signs were within normal limits. Physical exam showed clear breath
sounds with 2+ pitting edema in the lower legs and no rashes. Labs reveled a WBC of 20,000
cells/microliter, with creatinine of 2.29 mg/dL, bicarbonate of 17 mmol/L, and C-reactive peptide of 204
mg/L. UA showed moderate leukocyte esterase, trace protein, and large blood. Serum C3 and C4 levels
were normal, and a spot urine/protein ratio was 600 mg. Urine microscopy had several non-dysmorphic
RBCs with occasional RBC and WBC casts. Infectious work-up via COVID-19 screening, blood cultures,
hepatitis, and HIV was negative. The patient’s creatinine trended up, peaking at 2.8 mg/dL. She was
started on empiric solumedrol at a dose of 60 mg TID for possibilities of polymyalgia rheumatica or
vasculitis or NSAID-induced acute interstitial nephritis. She had a positive MPO ANCA with titer of 1:320.
Kidney biopsy confirmed pauci-immune crescentic glomerulonephritis, with clinical diagnosis of
microscopic polyangiitis. She was placed on prednisone 40 mg daily and rituximab 375 mg/m 2 weekly
for four weeks and was discharged home in stable condition.

Discussion

Systemic vasculitis remains to be a diagnostic challenge, especially in the era of COVID-19, given the
overlap in symptoms. The diagnosis is made via clinical history and histopathological findings coupled
with positive ANCA. Despite treatment, almost a quarter of these patients will progress to ESRD. In the
era of COVID-19, great care must be taken to diagnose the kidney manifestations of systemic vasculitis.