Post-Covid-19 Complications: Hemoptysis in a Middle-Aged Man

Abstract

Introduction: Sars-Cov-2 infection has been found to present differently in many patients. Patients have been found to have different degrees of response, likely having to do with variable levels of inflammation within the body. Patients who have recovered from the initial infection can develop long-term symptomatology and chronic conditions. Today, we will describe a unique case of a middle aged-healthy man who developed complications of ANCA-associated vasculitis after recovering from a mild COVID-19 infection. Case: A 51-year-old Hispanic male with no previous past medical history presented to the ED with productive sputum and hemoptysis. The patient had previously tested positive for COVID-19 one month prior, but did not require hospitalization. Physical exam findings were significant for diffuse, bilateral lower extremity palpable purpura. Initial workup was significant for CT Chest findings of diffuse patchy consolidations throughout both lungs with cavitary lesions. Additionally, the patient was found to have an acute kidney injury, with Cr 5.80 and GFR less than 10. UA revealed many red blood cells, +1 protein. Nephrology was consulted, started the patient on hemodialysis, and began workup for suspected acute glomerulonephritis (GN). Pulmonology was consulted and began workup for pulmonary renal syndrome in the setting of acute kidney injury with pulmonary disease.Infectious workup results included;a now negative COVID-19, negative Tuberculosis PCR, Respiratory culture revealing yeast. Additional workup revealed;CRP of greater than 200, D-Dimer of 6.41, Fibrinogen of 561. Notably, the patient had decreased complement C3 and C4 levels, negative Anti-GBM antibody, negative Anti-streptolysin O, positive ANCA assay, positive Proteinase antibody, and mildly positive Myeloperoxidase antibody.The patient was subsequently scheduled for renal biopsy to obtain a definitive diagnosis, but this was delayed due to increased INR. The patient's respiratory status worsened during hemodialysis. CTA at that time revealed markedly increased pulmonary infiltrates. The decision was made to intubate the patient, upon which active frank red bleeding arising from the trachea was noted. Shortly after intubation, the patient continued to hemorrhage and sustained 2 cardiac arrests;unfortunately, the patient expired. Discussion: This case is significant because it highlights a unique complication of COVID-19 leading to a possible ANCA-associated vasculitis. Much is to be learned from the Novel Sars-COV-2 virus and suspected complications and this case highlights the importance of keeping a broad differential when treating patients who have recovered from initial infection.