Danckers Mauricio, Zhou Fang, Nimeh Diana, Belmont H Michael, Steiger David J
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York University Langone Medical Center, New York, NY, USA.
Department of Pathology, New York University Langone Medical Center, New York, NY, USA.
Am J Case Rep. 2015 May 14;16:287-91. doi: 10.12659/AJCR.893406.
Granulomatosis with polyangiitis (GPA) relapse can complicate the differential diagnosis of pulmonary lesions.
A 70-year-old male smoker with GPA and emphysema presented with dyspnea, dry cough, and a right upper lobe pulmonary ground-glass opacity that persisted despite antibiotics. A trans-bronchial biopsy did not reveal active vasculitis, malignancy, or infection. He was treated for presumed GPA relapse based on pulmonary manifestations, renal failure, and elevated PR3-ANCA. Later, hematuria led to the cystoscopic discovery of a bladder wall lesion, which was diagnosed as micropapillary urothelial carcinoma not involving the muscularis propria. The patient developed an increasing pulmonary infiltrate with a new solid component, satellite lesions, and regional lymphadenopathy. A right upper lobe wedge resection showed metastatic urothelial carcinoma.
The simultaneous presentation of a pulmonary lesion and GPA relapse is a diagnostic challenge. The differential diagnosis should include the rare possibility of metastatic urothelial carcinoma, regardless of how the lesion appears radiographically.
肉芽肿性多血管炎（GPA）复发会使肺部病变的鉴别诊断变得复杂。
一名70岁男性吸烟者，患有GPA和肺气肿，出现呼吸困难、干咳，右上叶肺部磨玻璃影，尽管使用了抗生素仍持续存在。经支气管活检未发现活动性血管炎、恶性肿瘤或感染。基于肺部表现、肾衰竭和PR3-ANCA升高，对其进行了疑似GPA复发的治疗。后来，血尿导致膀胱镜检查发现膀胱壁病变，诊断为微乳头型尿路上皮癌，未累及固有肌层。患者肺部浸润加重，出现新的实性成分、卫星灶和区域淋巴结肿大。右上叶楔形切除术显示为转移性尿路上皮癌。
肺部病变与GPA复发同时出现是一个诊断挑战。鉴别诊断应包括转移性尿路上皮癌这种罕见可能性，无论病变在影像学上表现如何。
Zotero 插件