Mohan Abraham, Kuriakose Supriya M, James Lijo, G Bindu T, Jangra Suman, Jose Alisha T, M Deepu
Rheumatology, Caritas Hospital and Institute of Health Sciences, Kottayam, IND.
Otorhinolaryngology and Audiology, Caritas Hospital and Institute of Health Sciences, Kottayam, IND.
Cureus. 2024 Oct 7;16(10):e71009. doi: 10.7759/cureus.71009. eCollection 2024 Oct.
Granulomatosis with polyangiitis is a rare vasculitis characterized by necrotizing granulomatous inflammation affecting small blood vessels. It often presents with pulmonary masses and nodules, mimicking malignancy in imaging studies. Distinguishing granulomatosis with polyangiitis from cancer is crucial due to differing treatment approaches and prognoses. We describe a 54-year-old male with granulomatosis with polyangiitis presenting with headache, bilateral ear discharge, cough, and weight loss. Imaging revealed metabolically active lesions in the lungs and nasopharynx, initially suggestive of metastatic malignancy. Biopsies from the lung and nasopharyngeal lesions showed necrotizing granulomatous vasculitis, which was suggestive of granulomatosis with polyangiitis. Serological testing was positive for cytoplasmic antineutrophil cytoplasmic antibodies (c-ANCA) with elevated proteinase 3 (PR3) antibodies. This case underscores the diagnostic challenges of granulomatosis with polyangiitis, which can mimic malignancy radiologically. Early recognition and treatment initiation are pivotal in improving patient outcomes and preventing organ damage in granulomatosis with polyangiitis.
显微镜下多血管炎是一种罕见的血管炎，其特征是影响小血管的坏死性肉芽肿性炎症。它常表现为肺部肿块和结节，在影像学检查中类似恶性肿瘤。由于治疗方法和预后不同，将显微镜下多血管炎与癌症区分开来至关重要。我们描述了一名54岁男性，患有显微镜下多血管炎，表现为头痛、双侧耳部流脓、咳嗽和体重减轻。影像学检查显示肺部和鼻咽部有代谢活跃的病变，最初提示转移性恶性肿瘤。肺和鼻咽部病变的活检显示坏死性肉芽肿性血管炎，提示显微镜下多血管炎。血清学检测显示胞浆抗中性粒细胞胞浆抗体（c-ANCA）阳性，蛋白酶3（PR3）抗体升高。该病例强调了显微镜下多血管炎的诊断挑战，其在放射学上可类似恶性肿瘤。早期识别和开始治疗对于改善显微镜下多血管炎患者的预后和预防器官损伤至关重要。
