PMC8632021_01
(A) Pulmonary X-ray showing dense patchy consolidations in the left upper lung field. (B) Pulmonary computed tomography revealing peribronchial consolidations and ground glass opacities in the bilateral lung field, predominantly in the left upper lobe. (C) Light microscopy showing predominant vasculitis (parallel arrow) with pauci-immune crescent glomerulonephritis (horizontal arrow).
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F1
Pulmonary radiography and computed tomography showed bilateral peribronchial consolidations, which were predominantly located in the left upper lung (Figures 1A,B). After one session of emergent plasma exchange and intravenous steroid therapy, kidney biopsy was performed after obtaining informed consent, demonstrating acute severe renal vasculitis with pauci-immune crescent glomerulonephritis (Figure 1C).
Time and therapeutic course of anti-neutrophil cytoplasmic antibody-associated vasculitis with rapidly progressive glomerulonephritis following COVID-19 vaccination. PE, plasma exchange; P.S., pulse steroid; ANCA, anti-neutrophil cytoplasmic antibody; Anti-MPO, anti-myeloperoxidase-O, mo., month. Daily pulse steroid dosage: intravenous methylprednisolone 1,000 mg daily in the first course, then 500 mg daily in the following three courses.
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F2
The pulmonary hemorrhage was resolved and renal function was improved (serum creatinine, 2.5 mg/dL) 3 weeks later, following the continuous administration of combined plasma exchange, systemic steroid, and anti-CD20 therapy (500 mg) (Figure 2).