Article
Articular symptoms onset after SARS-CoV-2 infection in a patient with PR3-ANCA-associated vasculitis: a case report
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Authors
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Iryna Biriuchenko
- Bogomolets National Medical University, Department of Internal Medicine, Kyiv
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Viktor Korendovych
- Universitätsmedizin Göttingen, Klinik für Nephrologie und Rheumatologie, Göttingen
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Ludmyla Kryklyvets
- Zhytomyr Regional Clinical Hospital, Rheumatology, Zhytomyr
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Nataliia Korendovych
- Zhytomyr Regional Clinical Hospital, Internal Medicine, Zhytomyr
| Published: | September 14, 2021 |
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Outline
Text
A 48y.o. female presented in July 2018 with complaints of purulent-mucous secretions from nose, hearing loss, hoarseness, cough dyspnoea, fever and fatigue. The diagnosis of sinusitis was made by ENT-specialist but the treatment had no positive effect. Small vessel vasculitis was suspected and the patient was admitted to the rheumatological department. On admission: BMI 34, low grade fever, arterial BP 140/80 mm Hg. Laboratory tests revealed normochromic normocytic anemia, increased CRP (123mg/l) and ESR (69mm/h), blood urea (11.9 mmol/l), creatinine (287 mcmol/l) levels, proteinuria (0.8g/d) with mild erythrocyteuria, PR3-ANCA IgG 5.3 IU/ml quantitative (<2). High resolution thorax CT (HRCT) showed bilateral (lower lobes) cavitating nodules, sings of consolidation of pleural tissue, pleural effusion. Clinical diagnosis of PR3-ANCA-associated vasculitis was made. Initial treatment included high dose glucocorticoids (GC) and cyclophosphamide for remission induction with positive dynamics.
In January 2019 because of disease relapse, development of a saddle nose deformity, increased inflammatory markers and proteinurea (2.24g/d) the remission induction therapy was switched to rituximab (RTX) 375mg/m2 for 4 weeks + methylprednisolone 48 mg/d with tapering regimen. The patient showed good response: laboratory markers including proteinuria were improved, HRCT showed regressive changes of disease in lungs. For remission maintenance RTX (last infusion in August 2020) + low dose GC were used.
In October 2020 the patient was admitted to the Hospital because of SARS-CoV-2 infection. On thorax CT - signs of bilateral multifocal pneumonia with >50% of parenchymal involvement. For 5 days patient required mechanical ventilation and was discharged from the hospital in 29 days. In late January 2021 the symptoms of painful joint swellings on both hands, elbows, knees and mialgia occurred. Laboratory tests showed increased CRP (86.04mg/l) and ESR (58mm/h) only, other parameters including creatine phosphokinase, PR3-ANCA and standard rheumatoid panel were negative. On CT scans no new pulmonary lesions were detected. Because of good GC response we decided to continue the therapy with RTX 500mg at weeks 0 and 2 with tapering GC regimen. As of March 2021 the patient had no articular complaints together with normalisation of CRP level.
Disclosures: None declared
