Post COVID 19 autoimmune complications: Two cases

ABSTRACT

Background: Autoimmune disease in adults, among spectrum of complications of COVID 19 is rare. Case Study Both the cases were never smokers and had type 2 diabetes mellitus, hypertension and hypothyroidism with history of severe COVID 19 eleven months back in case I and seven months back in case II. Case I is 36 year old female, had off and on cough and fever (with spikes of 102o F) for one month along with loss of appetite and weight. CECT thorax showed multifocal GGOs and nodules and CT guided biopsy showed epitheliod granulomas. Fever had not responded to course of ATT. Monteux test showed no induration and BAL was negative for CBNAAT, fungal smear and culture and malignant cytology for both patients. PET CT showed metabolically active bilateral lung nodules. NCCT PNS was suggestive of pansinusitis. cANCA was positive. Case II is a 63 year male, had off and on dry cough and dyspnea off and on (grade 2 mMRC) for 2 months associated with loss of appetite and weight. Hb was 6 gm/ dl and indirect Coombs test was positive. USG whole abdomen showed coarse echotexture with multiple small nodular hypoechoic lesions in liver and spleen and splenomegaly. Serum ACE level was 95 mcg/ L. CECT thorax showed discrete areas of consolidation and ground glass opacity with perifissural and peribronchovascular nodules. TBLB showed non necrotizing granulomatous inflammation. Diagnosis of post COVID ANCA associated vasculitis was made in case I and post COVID sarcoidosis in case II. Both patients responded to immunosuppression. Discussion: Literature shows evidence for similar pathogenesis and clinical-radiological aspects between the hyper-inflammatory diseases and Covid-19 which might explain SARS-CoV-2 for the development of a rapid autoimmune and/or autoinflammatory dysregulation. Host-pathogen interactions at different points of the viral life cycle seem to be important for explaining in part the heterogeneity of clinical pictures that characterize COVID-19. Conclusion: In this progressively increasing global COVID-19 pandemic, it remains necessary to investigate early to find the effects and interactions of various immunological and autoimmune diseases in patients with recent history of COVID-19 and further intervene.