Han Michael, Pan Corinna
Department of Respiratory and Sleep Medicine Sutherland Hospital Sydney New South Wales Australia.
Respirol Case Rep. 2021 Aug 9;9(9):e0824. doi: 10.1002/rcr2.824. eCollection 2021 Sep.
Patients with granulomatosis with polyangiitis (GPA) may present with varied manifestations including pulmonary masses and nodules. We report the case of a 45-year-old man presenting with cough, haemoptysis and weight loss in the context of a 20 pack-year past smoking history. Computed tomography (CT) of the chest and positron emission tomography/CT scan demonstrated two right upper lobe masses, bilateral lung nodules and mediastinal lymphadenopathy, with increased fluorodeoxyglucose avidity. Endobronchial and CT-guided lung biopsy demonstrated granulomatous inflammation and elevated c-ANCA/PR3 confirmed the diagnosis of GPA. The patient received induction therapy with methylprednisolone and rituximab with good clinical response. Our case highlights the importance of considering a wide range of differentials in patients with lung masses/nodules, including autoimmune pathologies.
肉芽肿性多血管炎（GPA）患者可能有多种表现，包括肺部肿块和结节。我们报告一例45岁男性病例，该患者有20包年的吸烟史，出现咳嗽、咯血和体重减轻。胸部计算机断层扫描（CT）和正电子发射断层扫描/CT显示右上叶有两个肿块、双侧肺结节和纵隔淋巴结肿大，氟脱氧葡萄糖摄取增加。支气管内及CT引导下肺活检显示肉芽肿性炎症，c-ANCA/PR3升高确诊为GPA。患者接受甲泼尼龙和利妥昔单抗诱导治疗，临床反应良好。我们的病例强调了在有肺部肿块/结节的患者中考虑多种不同鉴别诊断的重要性，包括自身免疫性疾病。
