Coronavirus-associated bronchiolitis in an immunocompetent adult with anti-glomerular basement membrane disease

Abstract

A 19-year-old male presented with a 1-month history of cough. Initial computed tomography scan of the chest demonstrated fairly diffuse centrilobular nodules with extensive tree-in-bud nodularity in both lungs. His nasopharyngeal sample for respiratory viruses was positive for coronavirus 229E by respiratory viral reverse-transcriptase polymerase chain reaction (RT-PCR). Within 48 hours of admission, the patient presented with hemoptysis and subsequent hypercapnic and hypoxemic respiratory failure requiring transfer to the intensive care unit for mechanical ventilation. He also developed acute renal failure and was initiated on plasma exchange and Methylprednisolone for possible renal-pulmonary syndrome. These therapies were discontinued when his first serum anti-GBM was negative. After 40 days of mechanical ventilation, the patient recovered fully and was discharged home. Three months after, he again developed acute renal failure with active sediment associated with a significantly elevated anti-GBM level. There were no pulmonary symptoms. He was diagnosed with anti-glomerular basement membrane disease on renal biopsy. This is an unusual case of acute bronchiolitis and respiratory failure presumed secondary to the low-pathogenic coronavirus 229E in an immunocompetent adult patient. The temporal association of the coronavirus infection and the first onset of anti-GBM disease may suggest a connection in the pathogenesis of these two diseases.