Assuntos
Doença Antimembrana Basal Glomerular/epidemiologia , Anticorpos Antivirais/sangue , Betacoronavirus/imunologia , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Glicoproteína da Espícula de Coronavírus/imunologia , Imunidade Adaptativa , Adulto , Idoso , Doença Antimembrana Basal Glomerular/diagnóstico , Doença Antimembrana Basal Glomerular/imunologia , Doença Antimembrana Basal Glomerular/virologia , Anticorpos Antivirais/imunologia , Betacoronavirus/genética , Betacoronavirus/isolamento & purificação , COVID-19 , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/virologia , Feminino , Membrana Basal Glomerular/imunologia , Membrana Basal Glomerular/patologia , Humanos , Incidência , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/imunologia , Pneumonia Viral/virologia , RNA Viral/isolamento & purificação , SARS-CoV-2RESUMO
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Assuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Doença Antimembrana Basal Glomerular/tratamento farmacológico , Betacoronavirus/imunologia , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Anticorpos Antivirais/sangue , Doença Antimembrana Basal Glomerular/diagnóstico por imagem , Doença Antimembrana Basal Glomerular/virologia , Infecções por Coronavirus/virologia , Membrana Basal Glomerular/patologia , Pneumonia Viral/virologia , Glomérulos Renais/patologia , Tomografia Computadorizada por Raios X , Imunossupressores/uso terapêuticoRESUMO
Anti-glomerular basement membrane (GBM) disease is a severe inflammatory renal disorder due to pathogenic autoantibodies directed mainly against the α3 chain of type IV collagen. In ~1/4 of patients with anti-GBM disease, antineutrophil cytoplasmic antibodies (ANCA) predominantly with myeloperoxidase (MPO) specificity can be detected. Although the inciting stimuli leading to the development of an immune response against the type IV collagen and neutrophils are unknown, evidence indicates that both genetic and environmental factors play a role. Of note, molecular mimicry between self-antigens and nonself-antigens such as antigenic determinants of microorganisms has been implicated in the pathogenesis of anti-GBM disease and ANCA-associated vasculitis. A mosquito-borne viral illness highly prevalent in the tropics and subtropics, dengue can be complicated by acute renal failure, proteinuria, hematuria and glomerulonephritis. We present a 66-year-old woman who was diagnosed with dengue infection and rapidly progressive glomerulonephritis during an outbreak of dengue in Honduras in the summer of 2013. Renal biopsy revealed severe crescentic glomerulonephritis. Immunofluorescence examination demonstrated strong linear IgG deposition along glomerular capillary walls. Serologic tests demonstrated antibodies against GBM, MPO and platelet glycoproteins. The patient was diagnosed with anti-GBM disease associated with p-ANCA with MPO specificity. Despite heavy immunosuppression and plasmapheresis, IgG titers against dengue virus continued to rise confirming the diagnosis of acute dengue infection. We present the first reported case of anti-GBM disease associated with p-ANCA with MPO specificity during dengue infection. This report calls for a heightened awareness of autoimmunity leading to crescentic glomerulonephritis in patients with dengue infection.