COVID-INDUCED OVERLAP SYNDROME OF MICROSCOPIC POLYANGIITIS, SYSTEMIC LUPUS ERYTHEMATOSUS, AND AUTOIMMUNE THYROIDITIS THROUGH THE PRISM OF A CLINICAL CASE

Authors:

Abstract:

The problem of the overlap syndromes development is gaining more and more relevance, especially in the post-COVID period. This is due to the debut of these diseases after a coronavirus infection, the severity of their course, and the difficulty of timely diagnosis and treatment. The aim of the study was to analyze the clinical case as unique with regard to the features of the debut and clinical course of the COVID-induced overlap syndrome of microscopic polyangiitis, systemic lupus erythematosus and autoimmune thyroiditis. The article analyzes data from the medical records of a 46-year-old inpatient who recently had a coronavirus infection. In the post-COVID period, the disease debuted as a pulmonary-renal syndrome against a background of fever. The presence of immunological markers of microscopic polyangiitis, systemic lupus erythematosus, and autoimmune thyroiditis gave rise to the identification of an overlap syndrome of these diseases. The results of a nephrobiopsy confirmed the presence of morphological changes in the kidney tissue typical for microscopic polyangiitis. The relevance of this clinical case is due to the extreme rarity of descriptions in the professional medical literature development an overlap syndrome of microscopic vasculitis and systemic lupus erythematosus in combination with autoimmune thyroiditis.

Keywords:

overlap syndrome microscopic polyangiitis systemic lupus erythematosus autoimmune thyroiditis coronavirus infection antineutrophil myeloperoxidase antibodies antibodies to double-stranded deoxyribonucleic acid

References:

1. Viunitska LV, Gavrilenko TI, Pidgaina OA, Ryzhkova NO, Protsenko GO. Osoblyvosti laboratornoi diahnostyky kolahenoziv. Ukr J Rheumatol. 2022;2(88):25-33. doi: 10.32471/rheumatology.2707-6970.88.17072. [in Ukrainian].
2. Yefremenkova LN, Kovalevska LA, Vrublevska SV, Hrytsyk VP, Kachurova IM, Syvyi SM, et al. Debiut systemnoho chervonoho vovchaka pislia perenesenoho COVID-19. Visn. morskoi med. 2023;1(98):86-91. doi: http://dx.doi.org/10.5281/zenodo.7806274. [in Ukrainian].
3. Kovalenko VM, Rekalov DH, Yatsyshchyn RI, Holovach IYu, Stanislavchuk MA, Ter-Vartanian SKh, et al. Systemnyi chervonyi vovchak. Klinichni rekomendatsii. Kyiv; 2020. 76 p. [in Ukrainian].
4. Oshlianska OA, Nadtochii TH, Yats KA. Perekhresni syndromy v praktytsi dytiachoho revmatoloha. Ukr. revmatolohichnyi zhurn. 2024;2(96):18-25. DOI: 10.32471/rheumatology.2707-6970.96.18766. [in Ukrainian].
5. Oshlianska OA, Okhotnikova OM, Zakharchuk OV, Rusak S.O. Multysystemnyi zapalnyi syndrom, asotsiiovanyi z infektsiieiu sars-cov-2, u ditei: nova khvoroba chy syndrom na prykladi klinichnoho vypadku. Ukr. revmatolohichnyi zhurn. 2021;2(84):1-10. DOI: 10.32471/rheumatology.2707-6970.84.16258. [in Ukrainian].
6. Talash VV. Overlap-syndrom systemnoho chervonoho vovchaka z vaskulitamy, asotsiiovanymy z antyneitrofilnymy tsytoplazmatychnymy antytilamy (ohliad literatury). Aktualni problemy suchasnoi med. 2025;25(1):260-266. doi: 10.31718/2077-1096.25.1.260. [in Ukrainian].
7. Kaidashev I, Shlykova O, Izmailova O, Torubara O, Yushchenko Y, Tyshkovska T, et al. Host gene variability and SARS-CoV-2 infection: A review article. Heliyon. 2021;7(8):e07863. doi: 10.1016/j.heliyon.2021.e07863.
8. Kato K, Kawamura T, Terashima R, Tsuchiya Y, Takahashi Y, Kasai K, et al. A Case of Systemic Lupus Erythematosus/Antineutrophil Cytoplasmic Antibody-Associated Vasculitis Overlap Syndrome with Dissociated Pathological and Immunological Findings. Case Rep Nephrol. 2020;2020:5698708. doi: 10.1155/2020/5698708.
9. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl [Internet]. 2012 [cited 2024 Sept 11];3(1):1-150. Available from: https://kdigo.org/wp-content/uploads/2017/02/KDIGO_2012_CKD_GL.pdf.
10. Mashinchi B, Aryannejad A, Namazi M, Moradi S, Masoumi Z, Parsaei A, et al. A case of C-ANCA-positive systematic lupus erythematous and ANCA-associated vasculitis overlap syndrome superimposed by COVID-19: a fatal trio. Mod Rheumatol Case Rep. 2023;7(1):117-121. doi: 10.1093/mrcr/rxab007.
11. National Kidney Foundation. KDOQI Clinical Practice Guideline for Diabetes and CKD: 2012 Update. Am J Kidney Dis. 2012;60(5):850-886. doi: 10.1053/j.ajkd.2012.07.005.
12. Overlap syndromes. BMJ Best Practice. [Internet]. 2023. [cited 2025 Apr 24]. Available from: https://bestpractice.bmj.com/topics/en-gb/1018.
13. Pyo JY, Lee LE, Park YB, Lee SW. Comparison of the 2022 ACR/EULAR Classification Criteria for Antineutrophil Cytoplasmic Antibody-Associated Vasculitis with Previous Criteria. Yonsei Med J. 2023;64(1):11-17. doi: 10.3349/ymj.2022.0435.
14. Senda A, Sasai R, Kato K, Nishibata Y, Masuda S, Ishizu A, et al. Involvement of neutrophil extracellular traps in the pathogenesis of glomerulonephritis in a case of systemic lupus erythematosus and antineutrophil cytoplasmic antibody-associated vasculitis overlap syndrome. CEN Case Rep. 2022;11(3):339-346. doi: 10.1007/s13730-021-00682-y.

Publication:

«World of Medicine and Biology» Vol. 21 No. 93 (2025) , с. 266-271
УДК 616.16-002.4:616.5-002.52:616.44-092

DOI:

https://doi.org/10.26724/2079-8334-2025-3-93-266-271