Complex Challenges in ANCA-Associated Vasculitis: A Case of COVID-19, Cytomegalovirus Pneumonitis, and Hemorrhagic Cholecystitis Following Rituximab Therapy.

ingentiumby ingentium

In Clinical Literature.

Publication date: May 01, 2026

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare autoimmune disease with significant infectious and hemorrhagic risks during immunosuppressive therapy. We describe an 81-year-old woman with perinuclear ANCA (p-ANCA)-associated vasculitis complicated by acute respiratory distress syndrome from concurrent COVID-19 and CMV pneumonitis following rituximab induction. Her course was further complicated by hemorrhagic cholecystitis, a rare bleeding manifestation, requiring percutaneous intervention. Careful adjustment of immunosuppression was necessary due to severe infections. This case highlights the complexity of managing AAV amid severe infections and rare hemorrhagic complications, emphasizing the need for vigilant monitoring and individualized therapy.

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Concepts Keywords
Cytomegalovirus congenital cytomegalovirus infection
Hemorrhagic covid-19
Old hemorrhagic cholecystitis
Rituximab rituximab therapy
Woman

Semantics

Type Source Name
disease MESH ANCA-Associated Vasculitis
disease MESH COVID-19
disease MESH Pneumonitis
disease MESH Cholecystitis
drug DRUGBANK Rituximab
disease MESH vasculitis
disease MESH autoimmune disease
disease MESH acute respiratory distress syndrome
disease MESH bleeding
disease MESH infections
pathway REACTOME Reproduction
drug DRUGBANK Coenzyme M
disease MESH Infectious Disease
pathway REACTOME Infectious disease
disease MESH congenital cytomegalovirus infection
disease MESH immune reconstitution inflammatory syndrome
disease MESH respiratory failure
drug DRUGBANK Cyclophosphamide
disease MESH death
disease MESH microscopic polyangiitis
disease MESH upper respiratory tract infection
disease MESH glomerulonephritis
disease MESH pulmonary hypertension
disease MESH included
drug DRUGBANK Prednisone
drug DRUGBANK Atovaquone
disease MESH hypertension
disease MESH prediabetes
disease MESH heart diseases
disease MESH pleural effusions
disease MESH interstitial lung disease
disease MESH edema
disease MESH hemoptysis
disease MESH emergency
drug DRUGBANK Oxygen
disease MESH glass
disease MESH pulmonary embolism
drug DRUGBANK Potassium
drug DRUGBANK Creatinine
drug DRUGBANK Urea
drug DRUGBANK Nitrogen
drug DRUGBANK Alkaline Phosphatase
drug DRUGBANK Prothrombin

Original Article

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