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Published on: February 8, 2019
Positive c-ANCA in a Patient with Lymphoma and Without Vasculitis
K K Zuckerman1, L Leventhal, C Wynne
1Division of Rheumafologv and the Department of Internal Medicine, the Graduate ospital, Philadelphia, Pennsylvnia.
Summary
Wegener's granulomatosis, a rare vasculitis, can mimic other conditions. This case highlights a patient with symptoms suggesting Wegener's granulomatosis but diagnosed with non-Hodgkin's lymphoma, emphasizing diagnostic challenges.
Area of Science:
- Rheumatology
- Oncology
- Pathology
Background:
- Wegener's granulomatosis is a rare systemic vasculitis affecting the respiratory tract and kidneys.
- Antineutrophil cytoplasmic antibody (ANCA)-cytoplasmic pattern is a key diagnostic marker for active Wegener's.
- Distinguishing Wegener's from other conditions with similar presentations is crucial for accurate diagnosis and treatment.
Purpose of the Study:
- To present a case study of a patient with symptoms mimicking Wegener's granulomatosis.
- To highlight the diagnostic challenges when ANCA antibodies are present but the underlying condition is different.
- To underscore the importance of considering alternative diagnoses in complex cases.
Main Methods:
- Case report of a patient with respiratory and renal symptoms.
- Laboratory testing including ANCA (antineutrophil cytoplasmic antibody) testing for proteinase-3 and myeloperoxidase.
- Diagnostic workup including biopsy and imaging to determine the final diagnosis.
Main Results:
- The patient presented with signs and symptoms suggestive of Wegener's granulomatosis.
- High levels of antibodies against proteinase-3 and myeloperoxidase were detected, typically associated with Wegener's.
- The final diagnosis revealed high-grade non-Hodgkin's lymphoma, not Wegener's granulomatosis.
Conclusions:
- Clinical presentation and serological markers can sometimes be misleading.
- High-grade non-Hodgkin's lymphoma can present with features mimicking autoimmune vasculitis.
- A comprehensive diagnostic approach is essential to differentiate between Wegener's granulomatosis and other conditions, particularly lymphoma.
