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Case report
Fulminant granulomatosis with polyangiitis presenting with diffuse alveolar haemorrhage following COVID-19
  1. Eric Lind,
  2. Andrew Jameson and
  3. Esaw Kurban
  1. Mercy Health St. Mary's Division of Infectious Disease and Michigan State University College of Human Medicine Department of Medicine, Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
  1. Correspondence to Eric Lind; linderic{at}msu.edu

Abstract

A 40-year-old man developed granulomatosis with polyangiitis (GPA) following a mild case of COVID-19. Initially, he experienced mild migrating joint pain for 2 months prior to testing positive for SARS-CoV-2 but dramatically worsened following resolution of his infection. The pain continued to progress until he suddenly develope haemoptysis, prompting him to present to a local hospital. The diagnosis of diffuse alveolar haemorrhage secondary to GPA was confirmed with labs, imaging and histopathology. Precipitous deterioration of GPA with concurrent COVID-19 infection indicates a possible temporal relationship. Since the onset of the pandemic, SARS-CoV-2 has been anecdotally associated with the development of various connective tissue disorders. The overlapping clinical presentations and similar appearance on lung imaging present clinicians with a diagnostic challenge. This underscores the importance of having a high index of suspicion of autoimmune diagnoses in patients who present with new or worsening findings following a COVID-19 infection.

  • infectious diseases
  • vasculitis
  • respiratory medicine
  • renal medicine

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/bcr-2021-242628

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    Footnotes

    • Twitter @EricLind16, @DrJaymoGR

    • Contributors EDL took care of this patient as a medical student. He wrote the report with editing from AJ. EK is a medical student that contributed to the planning of the report and content of the discussion section.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.