Diffuse alveolar hemorrhage as a life‑ threatening manifestation of newly diagnosed granulomatosis with polyangiitis following COVID-19 infection – a case report

Czech version

Authors: Pavlína Kostelníková ¹; Martina Skácelová ¹; Martin Špíšek ²; Miroslav Šimíček ³; Pavel Horák ¹
Authors‘ workplace: III. interní klinika – nefrologická, revmatologická a endokrinologická, FN Olomouc a LF UP Olomouc ¹; Interní oddělení, Nemocnice AGEL Valašské Meziříčí, a. s. ²; Plicní ambulance, Nemocnice AGEL Valašské Meziříčí, a. s. ³
Published in: Vnitř Lék 2022; 68(5): 290-294
Category: Main Topic
doi: https://doi.org/10.36290/vnl.2022.062

Overview

A case report of a patient with newly diagnosed granulomatosis with polyangiitis (GPA) after undergoing COVID-19 (Coronavirus Disease 2019) is discussed. GPA is one of the ANCA-associated vasculitis, which is characterized by the presence of autoantibodies against cytoplasmic enzymes neutrophils (Anti Neutrophil Cytoplasmatic Antibodies). It is a vasculitis that mainly affects small blood vessels, leading to damage to the kidneys, lungs, and upper respiratory tract, including the paranasal sinuses and orbits. This disease can result in an acute life-threatening condition. Such complications include diffuse alveolar hemorrhage (DAH), a condition characterized by blood leakage from the pulmonary vessels into the alveoli, often leading to acute vital signs and even respiratory failure. DAH can have many causes – autoimmune diseases including vasculitides as well as non-immunological causes. Early and adequate comprehensive therapy including immunosuppressive treatment (cyclophosphamide/rituximab and glucocorticoids) can be life-saving.

Keywords:

plasmapheresis – Cyclophosphamide – granulomatosis with polyangiitis – diffuse alveolar hemorrhage

Sources

1. Comarmond C, Cacoub P. Granulomatosis with polyangiitis (Wegener): Clinical aspects and treatment. J Autoimmun. 2014;13(8):1121-1125. Dostupné z DOI:<https://https://doi.org/10.1016/j.autrev.2014. 08. 017>.

2. Robson JC, Grayson PC, Ponte C et al. 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology Classification Criteria for Granulomatosis With Polyangiitis. Arthritis Rheumatol. 2022;74(3):393-399. Dostupné z DOI: <https://doi/10.1002/art.41986>.

3. Bradna P, Maňák J, Soukup T et al. Difuzní alveolární hemoragie – akutní, život ohrožující stav v revmatologii. Vnitř Lék. 2018;64:169-172. Dostupné z DOI: <https://doi:10.36290/vnl.2018.025>.

4. Krause ML, Cartin‑Ceba R, Specks U et al. Update on diffuse alveolar hemorrhage and pulmonary vasculitis. Immunol Allergy Clin North Am. 2012;32(4):587-600. Dostupné z DOI: <https://doi:10.1016/j.iac.2012. 08. 001>.

5. Panikkath D, Gadwala S, Mills B et al. Diffuse alveolar hemorrhage. Southwest respir crit care chron. 2015;3(9):19-27. Dostupné z WWW: <https://pulmonarychronicles.com/index.php/pulmonarychronicles/article/view/186>.

6. Löffler C, Mahrhold J, Fogarassy P. Two Immunocompromised Patients With Diffuse Alveolar Hemorrhage as a Complication of Severe Coronavirus Disease 2019. Chest. 2020;158(5):e215–e219. Dostupné z DOI: <https://doi:10.1016/j.chest.2020. 06. 051>.

7. Wang E, Lee T, Sharma P et al. The Perfect Storm: Diffuse Alveolar Hemorrhage after SARS‑COV-2 Infection. Chest. 2021;160(4):A1212-A1213. Dostupné z DOI: <https://doi:10.1016/j.chest.2021. 07. 1114>.

8. Madanchi N, Stingo FE, Patrick KC et al. Possible Association Between COVID-19 Infection and De Novo Antineutrophil Cytoplasmic Antibody‑Associated Vasculitis. Cureus. 2021;13(12). Dostupné z DOI:<https://doi:10.7759/cureus.20331>.

9. Quadrelli S, Dubinsky D, Solis M et al. Immune diffuse alveolar hemorrhage: Clinical presentation and outcome. Respir Med. 2017;129:59-62. Dostupné z DOI: <https://doi:10.1016/j.rmed.2017. 06. 003>.

10. De Prost N, Parrot A, Picard C et al. Diffuse alveolar haemorrhage: factors associated with in‑hospital and long‑term mortality. Eur Respir J. 2010;35(6):1303-1311. Dostupné z DOI:<https://doi10.1183/09031936.00075309>.

11. Nasser M, Cottin V. Alveolar Hemorrhage in Vasculitis (Primary and Secondary). Semin Respir Crit Care Med. 2018;39(4):482-493. Dostupné z DOI: <https://doi:10.1055/s-0038-1668533>.

12. Yates M, Watts RA, Bajema IM et al. EULAR/ERA‑EDTA recommendations for the management of ANCA‑associated vasculitis. Ann Rheum Dis. 2016;75(9):1583–1594. Dostupné z DOI: <https://doi:10.1136/annrheumdis-2016–209133>.

13. Walsh M, Merkel PA, Peh CA et al. Plasma Exchange and Glucocorticoids in Severe ANCA‑Associated Vasculitis. N Engl J Med. 2020;382(7):622-631. Dostupné z DOI: <https://doi:10.1056/NEJMc2004843>.

14. Čertíková Chábová V. Plazmaferéza a glukokortikoidy u těžké ANCA asociované vaskulitidy. Postgraduální nefrologie. 2020;18(1):21-23. Dostupné z WWW: <https://www.postgradualninefrologie. cz/cislo‑xviii-1/plazmafereza‑a‑glukokortikoidy‑u‑tezke‑anca‑asociovane‑vaskulitidy/>.

15. Derebail VK, Falk RJ. ANCA‑Associated Vasculitis – Refining Therapy with Plasma Exchange and Glucocorticoids. N Engl J Med. 2020;382:671-673. Dostupné z DOI: <https://doi:10.1056/NEJMe1917490>.

16. Chung SA, Langford CA, Maz M et al. 2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Antineutrophil Cytoplasmic Antibody–Associated Vasculitis. Arthritis Care Res. 2021;79(8):1088-1105. Dostupné z DOI: <https://doi:10.1002/acr.24634>.

17. Rawal G. ECMO Rescue Therapy in Diffuse Alveolar Haemorrhage: A Case Report with Review of Literature. J Clin Diagnostic Res. 2016;10(6):10-11. Dostupné z DOI: <https://doi:10.7860/JCDR/2016/20649.7969>.

18. Baker MS, Diab KJ, Carlos G et al. Intrapulmonary Recombinant Factor VII as an Effective Treatment for Diffuse Alveolar Hemorrhage: A Case Series. J Bronchology Interv Pulmonol 2016;23(3):255-258. Dostupné z DOI: <https://doi:10.1097/LBR.0000000000000286>.