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Abstract: PO0120

ANCA Vasculitis Presenting as Hemoptysis Post COVID-19 Infection

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Manivannan, Surya, University of North Carolina System, Chapel Hill, North Carolina, United States
  • Jain, Koyal, University of North Carolina System, Chapel Hill, North Carolina, United States
Introduction

COVID-19 infection has been suggested to be a trigger for a de-novo autoimmune response. This case represents one of a few reported cases of ANCA-vasculitis developing after a COVID infection.

Case Description

A 41-year-old female with a history of chronic sinusitis (not vasculitis related), obesity, right pulmonary sequestration, and mild COVID-19 infection 1-month prior manifesting as only mild cough with loss of taste and smell, was admitted with a 2-week history of progressive cough productive of blood-tinged sputum and lower extremity neuropathy. CTA of her chest showed air space opacities in right lower lobe concerning for bacterial superinfection in a host with altered pulmonary architecture. She was treated for presumed community acquired pneumonia. A week later, she presented with worsening hemoptysis and respiratory failure requiring intubation, which escalated quickly to needing extracorporeal membrane oxygenation (ECMO). Extensive bilateral airspace infiltrates due to diffuse alveolar hemorrhage and a PR3-ANCA level of 175 U/ml were strongly suggestive of a new diagnosis of ANCA-vasculitis (granulomatosis with polyangiitis). Her renal function remained normal, and urine sediment had no findings to indicate an ongoing concurrent nephritic process. She was given high dose pulse intravenous steroids, recombinant factor VII, 7 sessions of daily plasma exchange, intravenous tranexamic acid, and 1 dose of Cytoxan 500 mg/m2. She briefly had clinical improvement and required decreased ECMO support, but unfortunately, she later developed worsening pulmonary hemorrhage and hypotension, which was attributed to acute respiratory distress syndrome and thrombocytopenia, as opposed to immune mediated capillaritis. After 2 weeks of treatment, she was terminally decannulated.

Discussion

This is a rare case of ANCA-vasculitis likely triggered by COVID-19 infection. The presence of peripheral neuropathy indicates that she probably had extrapulmonary manifestations of vasculitis, although she had no evidence of renal involvement. This case report demonstrates that a high index of suspicion is needed for a new diagnosis of ANCA-vasculitis in patients with a prior history of COVID-19 infection to allow for prompt diagnosis and appropriate management.