Pulmonary-renal Syndrome Caused by an Overlap Systemic Lupus Erythematosus/Antineutrophil Cytoplasmic Antibody-associated Vasculitis Syndrome in the Setting of Immune Complex-mediated Glomerulonephritis in a Patient with COVID-19 Infection.

The COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 continues to be a global public health issue. Kidney disease is common, mainly presenting as acute kidney injury. Glomerular diseases have been reported in COVID-19. We are presenting a case of immune complex-mediated glomerulonephritis in a patient with COVID-19 infection and probable superimposed systemic lupus erythematosus and antineutrophil cytoplasmic antibody-associated vasculitis overlap who developed a pulmonary-renal syndrome. The patient responded well with a combination of plasma exchange, rituximab, and glucocorticoid therapy. The treatment was successful with resolution of the diffuse alveolar hemorrhage and prevention of potential end stage kidney disease. We would like to add this case to the literature as another example of the long-ranging potential autoimmune/autoinflammatory complications associated with COVID-19 disease.