COVID-19 usually presents with classic signs and symptoms, but it can involve multiple systems in atypical cases. SARS-CoV-2 has a complex interaction with the host immune system leading to atypical manifestations. In our case, a 32-year-old male patient presented with
fatigue, sores on hands and feet,
headache, productive
cough with blood-tinged mucus, conjunctival
hyperemia, purpuric
rash on hands and feet, and splinter
hemorrhages of fingernails for 2 weeks. The patient's SARS-CoV-2
antigen and PCR test were positive. Chest X-ray showed mixed density perihilar opacities in both lungs. Computed tomography of the chest showed extensive airspace opacities in both lungs, suggesting
COVID-19 multifocal, multilobar
pneumonitis. A renal biopsy indicated limited
thrombotic microangiopathy and
tubulointerstitial nephritis, for which he was started on
steroids, and his renal functions gradually improved. He tested positive for
C-ANCA during an immune workup. He was discharged with a
steroid taper for
nephritis. Once the taper reached less than 10 mg/day, he developed acute
scleritis and a new pulmonary cavitary lesion of 6 cm. The biopsy via bronchoscopy revealed acute inflammatory cells with
hemosiderin-laden macrophages. He was restarted on systemic
steroids for
scleritis after failing topical
steroids, which incidentally also reduced the size of the cavitary lesion, indicating an immune component. Our case demonstrates the involvement of kidneys and
vasculitis of the skin, sclera, and lungs by
COVID-19. The patient's symptoms were not explained by any diseases other than
COVID-19. Atypical cases of
COVID-19 disease with multifocal systemic symptoms involving the skin, sclera, lungs, and kidneys should be high on differentials. Early recognition and intervention may decrease
hospital stays and morbidity.