PULMONARY RENAL SYNDROME CAUSED BY ANTI-GLOMERULAR BASEMENT MEMBRANE DISEASE IN COMBINATION WITH ANCA- ASSOCIATED VASCULITIS AFTER SARS-COV-2 INFECTION

Abstract

Introduction. Pulmonary-renal syndrome (PRS) manifested by a combination of idiopathic pulmonary alveolar hemorrhage and rapidly progressing glomerulonephritis, is most commonly associated with either anti-neutrophil cytoplasmic antibodies (ANCA) or anti-glomerular basement membrane (anti-GBM) antibodies. Despite the rather rarity of this disease, there is a sufficient number of observations with the simultaneous presence of both types of antibodies, the so-called double antibody-positive phenotype. During the pandemic of SARS-CoV-2 infection an increase in cases of PRS was noted, however, the phenomenon of double antibody positi¬vity – ANCA plus anti-GBM – is still a clinical casuistry. Observation. A 64-year-old woman was hospitalized 2 months after SARS-CoV-2 infection with PRS of a severe course with rapidly progressing renal failure, as well as lung affection with hemoptysis and typical changes on multidetector computed tomography. The patient was found to be double positive for ANCA and anti-GBM. Therapy including plasma exchanges, high doses of steroids and cyclophosphamide was carried out which gave a short-term improvement, but did not prevent dependence on hemodialysis. 7 months after the onset of PRS the patient died from a secondary infection. According to the pathoanatomical study, the diagnosis of anti-GBM disease in combination with ANCA-associated vasculitis was confirmed. Conclusion. As far as we know, this is the second reported case of 'double antibody' PRS after SARS-CoV-2 infection. We believe that in all such clinical situations it is necessary to test for both types of antibodies as this will determine the clinical tactics.