TP031 INTERESTING CASES ASSOCIATED WITH SARS-COV-2 INFECTION / Thematic Poster Session

Post-Covid-19 Complications: Hemoptysis in a Middle-Aged Man

K. D. Patel1, D. Morris 2, A. Iardino3; 1Department of Internal Medicine, University of Nevada Las Vegas- School of
Medicine, Las Vegas, NV, United States, 2University of Nevada Las Vegas- School of Medicine, Las Vegas, NV,
United States, 3Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of
Nevada - Las Vegas, Las Vegas, NV, United States.

Introduction: Sars-Cov-2 infection has been found to present differently in many patients. Patients have been
found to have different degrees of response, likely having to do with variable levels of inflammation within the
body. Patients who have recovered from the initial infection can develop long-term symptomatology and chronic
conditions. Today, we will describe a unique case of a middle aged-healthy man who developed complications of
ANCA-associated vasculitis after recovering from a mild COVID-19 infection. Case: A 51-year-old Hispanic male
with no previous past medical history presented to the ED with productive sputum and hemoptysis. The patient
had previously tested positive for COVID-19 one month prior, but did not require hospitalization. Physical exam
findings were significant for diffuse, bilateral lower extremity palpable purpura. Initial workup was significant for
CT Chest findings of diffuse patchy consolidations throughout both lungs with cavitary lesions. Additionally, the
patient was found to have an acute kidney injury, with Cr 5.80 and GFR less than 10. UA revealed many red
blood cells, +1 protein. Nephrology was consulted, started the patient on hemodialysis, and began workup for
suspected acute glomerulonephritis (GN). Pulmonology was consulted and began workup for pulmonary renal
syndrome in the setting of acute kidney injury with pulmonary disease.Infectious workup results included; a now
negative COVID-19, negative Tuberculosis PCR, Respiratory culture revealing yeast. Additional workup revealed;
CRP of greater than 200, D-Dimer of 6.41, Fibrinogen of 561. Notably, the patient had decreased complement
C3 and C4 levels, negative Anti-GBM antibody, negative Anti-streptolysin O, positive ANCA assay, positive
Proteinase antibody, and mildly positive Myeloperoxidase antibody.The patient was subsequently scheduled for
renal biopsy to obtain a definitive diagnosis, but this was delayed due to increased INR. The patient’s respiratory
status worsened during hemodialysis. CTA at that time revealed markedly increased pulmonary infiltrates. The
decision was made to intubate the patient, upon which active frank red bleeding arising from the trachea was
noted. Shortly after intubation, the patient continued to hemorrhage and sustained 2 cardiac arrests;
unfortunately, the patient expired. Discussion: This case is significant because it highlights a unique complication
of COVID-19 leading to a possible ANCA-associated vasculitis. Much is to be learned from the Novel Sars-COV-2
virus and suspected complications and this case highlights the importance of keeping a broad differential when
treating patients who have recovered from initial infection.

This abstract is funded by: None

Am J Respir Crit Care Med 2021;203:A2012

Internet address: www.atsjournals.org Online Abstracts Issue