Background: Perinuclear anti-neutrophil cytoplasmic antibodies (P-ANCA),
a subset of ANCA, are associated with a multisystem vasculitis affecting
small blood vessels in the body. A handful of adult patients who
developed vasculitis post-COVID-19 infection have been reported.
Although COVID-19 infection has been shown to drive an exaggerated
immune response in the pediatric population, such as MIS-C (multisystem
inflammatory syndrome in children), only one case of vasculitis
following COVID-19 infection has been reported previously in children.
Case presentation: Seventeen-year-old male with a past medical history
of COVID-19 pneumonia two months prior presented with acute kidney
injury/failure and diffuse alveolar hemorrhage (DAH). Rheumatologic
workup revealed P-ANCA and Myeloperoxidase (MPO) positivity. Kidney
biopsy showed necrotizing glomerulonephritis with limited immune complex
deposition. Subsequently, he was treated with pulse steroids,
plasmapheresis, and ultimately started on cyclophosphamide. Conclusions:
To our knowledge, this report presents the second reported pediatric
case of P-ANCA / MPO vasculitis following COVID-19 infection.