Tuberculosis, granulomatosis with polyangiitis, or both? A case report.

Area of Science:

• Pulmonology
• Rheumatology
• Ophthalmology

Background:

• Tuberculosis (TB) is a chronic granulomatous infection affecting the lungs.
• Granulomatosis with polyangiitis (GP) is a rare small vessel vasculitis also impacting the lungs.
• The co-occurrence of TB and GP is uncommon, complicating differential diagnosis due to overlapping clinical presentations.

Observation:

• A 37-year-old female patient, treated for pulmonary TB, developed left ocular proptosis, eyelid/conjunctival edema, and erythema.
• Orbital biopsy confirmed granulomatosis with polyangiitis (GP).
• Elevated C-anti-neutrophil cytoplasmic antibodies (C-ANCA) were detected.

Findings:

• The patient demonstrated a positive response to immunosuppressive therapy.
• Diagnostic confirmation of co-existing TB and GP was achieved.
• Combined serological (C-ANCA) and histopathological (biopsy) evidence was crucial.

Implications:

• This case highlights the possibility of concurrent TB and GP infections.
• Accurate diagnosis necessitates a comprehensive approach, including C-ANCA testing and orbital biopsy.
• Timely and accurate diagnosis is essential for selecting appropriate immunosuppressive and anti-TB treatments.