Anti-neutrophilic Antibody-positive Systemic Lupus Erythematosus with Acute Kidney Injury and Diffuse Alveolar Hemorrhage with Concomitant Coronavirus Disease 2019 (COVID-19)

Abstract

A Japanese woman in her 30s with a six-month history of ANCA-positive SLE was admitted because of acute kidney injury (AKI). Three weeks before admission, her condition was well-controlled. On admission, the test for SARS-CoV-2 was positive; she showed marked renal dysfunction but no pulmonary abnormalities, suggesting COVID-19 infection. She underwent continuous hemodiafiltration and received glucocorticoid pulse therapy and remdesivir. The next day, she developed diffuse alveolar hemorrhage (DAH) and cytokine storm. She died despite intensive care. We assumed that AKI and DAH were caused by SLE exacerbation triggered by the COVID-19 infection in addition to the COVID-19 infection itself.