Abstract:

Anti-glomerular basement membrane (anti-GBM) disease is a rare autoimmune condition that leads to rapidly progressive glomerulonephritis, particularly uncommon in children. An 8-year-old boy was admitted to the emergency department presenting with macroscopic hematuria and oliguria. Notably, he had been hospitalized 5 weeks earlier due to a COVID-19 infection, with subsequent negative COVID-PCR results upon discharge. The systemic physical examination revealed pretibial and periorbital edema, but it was otherwise unremarkable. Importantly, there was no hypocomplementemia, and all autoantibodies tested were negative, except for anti-GBM antibodies. Over the 2-day follow-up, serum creatinine levels exhibited a steady increase from 0.63 to 6.4 mg/dL. Renal biopsy result indicated crescentic glomerulonephritis associated with anti-GBM disease. The patient responded positively to treatment with methylprednisolone, cyclophosphamide, and plasmapheresis, followed by intravenous immunoglobulin. The patient showed remarkable improvement, with the last recorded serum creatinine level at 0.57 mg/dL. Our case report suggests a potential pathogenic association between COVID-19 infection and the development of anti-GBM disease, resulting in a rapidly progressive form of crescentic glomerulonephritis in children.

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