SARS-CoV-2 infection and recurrence of anti-glomerular basement disease: a case report

BMC Nephrology

Alexander Winkler¹  Emanuel Zitt¹  Hannelore Sprenger-Mähr¹  Karl Lhotta¹  Manfred Cejna²  Afschin Soleiman³ 

[1] Department of Internal Medicine 3 (Nephrology and Dialysis), Feldkirch Academic Teaching Hospital, Carinagasse 47, A-6800, Feldkirch, Austria;Institute for Diagnostic and Interventional Radiology, Feldkirch Academic Teaching Hospital, Feldkirch, Austria;Pathology, Cytodiagnostics and Molecular Pathology, Hall in Tirol, Austria;

关键词: Anti-GBM disease;    SARS-CoV-2;    COVID-19;    Glomerulonephritis;    Case report;   

DOI  :  10.1186/s12882-021-02275-4

来源: Springer

【 摘 要 】

BackgroundAnti-glomerular basement membrane disease (GBM) disease is a rare autoimmune disease causing rapidly progressive glomerulonephritis and pulmonary haemorrhage. Recently, an association between COVID-19 and anti-glomerular basement membrane (anti-GBM) disease has been proposed. We report on a patient with recurrence of anti-GBM disease after SARS-CoV-2 infection.Case presentationThe 31-year-old woman had a past medical history of anti-GBM disease, first diagnosed 11 years ago, and a first relapse 5 years ago. She was admitted with severe dyspnoea, haemoptysis, pulmonary infiltrates and acute on chronic kidney injury. A SARS-CoV-2 PCR was positive with a high cycle threshold. Anti-GBM autoantibodies were undetectable. A kidney biopsy revealed necrotising crescentic glomerulonephritis with linear deposits of IgG, IgM and C3 along the glomerular basement membrane, confirming a recurrence of anti-GBM disease. She was treated with steroids, plasma exchange and two doses of rituximab. Pulmonary disease resolved, but the patient remained dialysis-dependent. We propose that pulmonary involvement of COVID-19 caused exposure of alveolar basement membranes leading to the production of high avidity autoantibodies by long-lived plasma cells, resulting in severe pulmonary renal syndrome.ConclusionOur case supports the assumption of a possible association between COVID-19 and anti-GBM disease.

【 授权许可】

CC BY