Post COVID immune phenomena: Expanded role of the Nephrologist

Abstract

Aims and objectives: To describe the diagnosis, management and outcomes of 5 cases of post COVID immune disorders that needed intervention from the Department of Nephrology in a single center. Materials and Methods: Five cases of post COVID immune disease detected at VPS Lakeshore Hospital and Research Centre, Kochi have been described. All cases were diagnosed with an RT-PCR assay. Their management and final outcomes also were analyzed. Results: 2 cases of post COVID diffuse alveolar hemorrhage, 2 cases of post COVID systemic lupus erythematous (SLE) and 1 case of post COVID macrophage activation syndrome with ANA and APLA positivity have been described. The two patients of diffuse alveolar hemorrhage required plasma exchange and immunosuppression and made a full recovery. One patient with SLE made a full recovery and underwent a kidney transplant. The other patient with SLE succumbed to bacterial meningitis 10 months after starting treatment. One patient with post COVID macrophage activation syndrome with ANA and APLA positivity responded to high dose steroids and intravenous immunoglobulin and made a complete recovery Conclusions: Post COVID immune phenomena may present in multiple ways such as diffuse alveolar hemorrhage, skin vasculitis, macrophage activation syndrome and new onset systemic lupus erythematous. These conditions may present in atypical age groups and in varying combinations. A high index of suspicion and quick diagnosis is imperative in the management of these rare conditions.