ABSTRACT
BACKGROUND: Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a systemic disease leading to renal complications of pauci-immune focal and segmental necrotizing crescentic glomerulonephritis (PI-NCGN). CASE DESCRIPTION: We present a 57-year-old female patient with rapidly progressive glomerulonephritis, multiple systemic infections [candidiasis and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)], severe weight loss, arthralgia, positive myeloperoxidase ANCA, acute deterioration of cardiac function and NCGN with heavy deposition of immunoglobulin (Ig) A and complement 3 (C3) in kidney biopsy. After two months of follow-up and appropriate treatments [methylprednisolone (60 mg/day), cyclophosphamide (15 mg/kg)], our patient recovered from multiple life-threatening infections, including candidiasis treated by fluconazole and SARS-CoV-2 treated by methylprednisolone and acute cardiac failure. In addition, she was saved from dialysis despite all poor prognostic factors. CONCLUSION: AAV might lead to immune complex deposition in kidneys due to different pathogenetic mechanisms like complement activation and immune complex formation, apart from losing tolerance to neutrophil proteins. HIPPOKRATIA 2022, 26 (2):86-88.
ABSTRACT
The novel and worldwide spread of coronavirus disease 2019 has important thrombotic complications, making it necessary to treat it with low-molecular-weight heparin. However, though it is very rare, it should be kept in mind that coronavirus disease 2019 infection might be complicated by thrombotic thrombocytopenic purpura, resulting in severe thrombocytopenia which makes heparin use contraindicated. The complications of thrombotic thrombocytopenic purpura have been elucidated after this pandemic infection. We report a case of acquired thrombotic thrombocytopenic purpura due to late hematological manifestation of coronavirus disease 2019 infection. A 47-year-old male patient who developed microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury (stage 3) with macroalbuminuria was diagnosed with thrombotic thrombocytopenic purpura based on very low plasma ADAMTS13 activity and borderline ADAMTS13 inhibitor level 4 weeks after coronavirus disease 2019 infection detected by positive nucleic acid amplification test (reverse-transc ription polymerase chain reaction). Coronavirus disease 2019 infection usually leads to thrombotic events, making it necessary to treat it with low-molecular-weight heparin. However, even though it is very rare, it should be kept in mind that coronavirus disease 2019 infection might be complicated by thrombotic thrombocytopenic purpura, resulting in severe thrombocytopenia, which makes heparin use contraindicated. This is the first case reporting the appearance of stage 3 acute kidney injury in thrombotic thrombocytopenic purpura due to coronavirus disease 2019 infection after a window period of 1 month and successful treatment with only steroids. © 2022 Turkish Society of Nephrology. All rights reserved.