Abstract
Background Covid-19 infection poses a serious challenge for immune-compromised patients with inflammatory autoimmune systemic diseases. This is likely due to a combination of immune dysfunction, immunosuppressive therapy and excess co-morbidities.
Patients with systemic lupus erythematosus (SLE) are at increased risk for severe cases of COVID 19 and short term outcomes, such as hospitalization, venous thromboembolism.
Purpose we report the severe outcomes of COVID 19 infection among a patient with an underlying lupus nephritis.
Methods we present the case of a young female with a past medical history of lupus nephritis who was admitted to the internal medecine unit during COVID 19 pandemic.
Results We report the case of a 35 year old female, with underlying lupus nephritis associated to CKD, secondary jogren’s syndrome who complaints of fever, persistent cough, dyspnea and lower limb weakness. The patient medication included hydroxychloroquine, a high dose of oral steroid (80mg per day). The patient was obese (BMI :30 kg/m²) , and had a minor respiratory distress (SaO2 was 82% on room air, respiratory rate at 32 cy/mn). Examination identified weakness in lower limbs and areflexia, no deep venous thrombosis signs.
The result of laboratory tests showed pancytopenia, high C reactive protein, hepatic cytolisis without signs of liver failure. Computed tomography of the chest showed ground glass opacities of both lungs (50–75%). SARS-Cov-2 was detected in the nasal swab by RT-PCR test. Lumbar puncture revealed a high CSF protein with normal cell count and negative cultures.
Investigations were consistent with polyradiculonevritis and additional COVID-19 (SARS-CoV-2) infection. The patient received non invasive ventilation dual oxygen therapy , high dose of heparin, antibiotics and physiotherapy.
The patient recovered after 2 weeks and showed signs of motor improvement 2 months after admission.
Discussion Among patients with SLE, those who contracted COVID 19 had significant increased risks for mortality, mechanical ventilation, ICU admission and hospitalization respectively compared with those without COVID 19. The presence of lupus nephritis, compared with its absence, was associated with significant and increased risks for hospitalization, sepsis, and AKI. It was found that lupus nephritis was the only predictor of severe to critical COVID 19 in SLE.
Conclusion This case illustrates the severe prognosis among patients with SLE and specially those with a lupus nephritis. This is an important alert to those caring for patients with SLE, and a reminder of the importance of preventive measures, such as vaccines, during a pandemic for this population.
