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Ali S, Almas T, Zaidi U, Ahmed F, Shaikh S, Shaikh F, Tafveez R, Arsalan M, Antony I, Antony M, Tahir B, Aborode AT, Ali M, Nagarajan VR, Samy A, Alrawashdeh MM, Alkhattab M, Ramjohn J, Ramjohn J, Huang H, Nawaz QS, Khan KA, Khullar S. A novel case of lupus nephritis and mixed connective tissue disorder in a COVID-19 patient. Ann Med Surg (Lond) 2022; 78:103653. [PMID: 35495962 PMCID: PMC9034828 DOI: 10.1016/j.amsu.2022.103653] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/15/2022] [Accepted: 04/17/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Mixed connective tissue disease (MCTD) is a rare autoimmune condition characterized by Scleroderma, Polymyositis, and Systemic Lupus Erythematous (SLE). Though a possible relationship between COVID-19 and autoimmune diseases has been recently reported, its pathophysiological mechanism behind flares in Lupus Nephritis (LN), a complication of SLE, remains unknown. Case presentation A 22-year-old COVID-19 positive female presented with anemia, bilateral pitting edema, periorbital swelling, and posterior cervical lymphadenitis. Further inspection revealed lower abdominal striae, hepatosplenomegaly, and hyperpigmented skin nodules. Complete blood counts showed elevated inflammatory markers and excessively high protein creatinine ratio. Antinuclear antibody titers were elevated (anti-smith and U1 small nuclear ribonucleoprotein) and Rheumatoid Factor was positive. She was diagnosed with MCTD associated with a flare of LN. To control her lupus flare, a lower dose of steroids was initially administered, in addition to oral hydroxychloroquine and intravenous cyclophosphamide. Her condition steadily improved and was discharged on oral steroid maintenance medication. Discussion We present a rare phenomenon of newly diagnosed LN, a complication of SLE, with MCTD in a PCR-confirmed COVID-19 patient. The diagnostic conundrum and treatment hurdles should be carefully addressed when patients present with lupus and COVID-19 pneumonia, with further exploration of the immuno-pathophysiology of COVID-19 infection in multi-systemic organ dysfunction in autoimmune disorders. Conclusion In COVID-19 patients with LN and acute renal injury, it is critical to promptly and cautiously treat symptomatic flares associated with autoimmune disorders such as SLE and MCTD that may have gone unnoticed to prevent morbidity from an additional respiratory infection. SLE disease has been associated with COVID-19. However, there is a lack of data on LN in conjunction with MCTD in COVID-19 positive patients. A possible relationship between Coronavirus disease 2019 (COVID-19) and autoimmune disease has been documented in many case reports. Because of the overlapping clinical manifestations and laboratory findings between lupus and COVID-19 pneumonia, the diagnostic problems and treatment hurdles should be carefully addressed. In COVID-19 patients with LN flare and acute renal injury, it is critical to resolve any reversible causes of the kidney injury and manage the COVID-19 before treating the LN.
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Affiliation(s)
- Sajjad Ali
- Department of Medicine, Ziauddin Medical University, Karachi, Pakistan
- Corresponding author. Department of Medicine, Ziauddin Medical University, Karachi, Pakistan.
| | - Talal Almas
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Ujala Zaidi
- Department of Medicine, Karachi Medical and Dental College, Karachi, Pakistan
| | - Farea Ahmed
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | | | - Rida Tafveez
- Department of Medicine, Ziauddin Medical University, Karachi, Pakistan
| | - Maaz Arsalan
- Department of Medicine, Ziauddin Medical University, Karachi, Pakistan
| | - Ishan Antony
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Burhanuddin Tahir
- Department of Medicine, Ziauddin Medical University, Karachi, Pakistan
| | | | - Murtaza Ali
- Department of Medicine, Dr. Ruth K.M. Pfau, Civil Hospital Karachi, Pakistan
| | | | - Arjun Samy
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Maha Alkhattab
- Department of Surgery, Galway University Hospital, Galway, Ireland
| | | | | | - Helen Huang
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | | | - Shane Khullar
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Vertui V, Zanframundo G, Castañeda S, Biglia A, Palermo BL, Cavazzana I, Meloni F, Cavagna L. Clinical evolution of antisynthetase syndrome after SARS-CoV2 infection: a 6-month follow-up analysis. Clin Rheumatol 2022; 41:2601-2604. [PMID: 35612768 PMCID: PMC9130053 DOI: 10.1007/s10067-022-06216-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Valentina Vertui
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation, Pavia, Italy. .,Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Lombardia, Italy.
| | - Giovanni Zanframundo
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Lombardia, Italy.,Division of Rheumatology, IRCCS Policlinico S. Matteo Foundation, Pavia, Lombardia, Italy
| | - Santos Castañeda
- Rheumatology Division, Hospital de La Princesa, c/ Diego de León 62, IIS-IP, Madrid, Spain.,Catedra UAM-Roche, EPID-Future, Medicine Department, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Alessandro Biglia
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Lombardia, Italy.,Division of Rheumatology, IRCCS Policlinico S. Matteo Foundation, Pavia, Lombardia, Italy
| | - Bianca Lucia Palermo
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Lombardia, Italy.,Division of Rheumatology, IRCCS Policlinico S. Matteo Foundation, Pavia, Lombardia, Italy
| | - Ilaria Cavazzana
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Brescia, Italy
| | - Federica Meloni
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Lombardia, Italy.,U.O.S. Transplant Center, IRCCS Policlinico S. Matteo Foundation of Pavia, Pavia, Italy
| | - Lorenzo Cavagna
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Lombardia, Italy.,Division of Rheumatology, IRCCS Policlinico S. Matteo Foundation, Pavia, Lombardia, Italy
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