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Granulomatous Disorder With Pulmonary and Renal Involvement: A Diagnostic and Therapeutic Dilemma

Merina Khan1, Nida Saleem1, Syed Nayer Mahmud1

  • 1Nephrology, Shifa International Hospital Islamabad, Islamabad, PAK.

Cureus
|April 21, 2022
PubMed

Insights

Granulomatosis with polyangiitis (GPA) can mimic other conditions. This case highlights GPA presenting as a mediastinal mass, emphasizing the need for differential diagnosis in such presentations.

Area of Science:

  • Pulmonology
  • Rheumatology
  • Pathology

Background:

  • Granulomatosis with polyangiitis (GPA) is a rare systemic vasculitis.
  • GPA diagnosis can be challenging due to diverse clinical presentations.
  • Mediastinal masses require thorough differential diagnosis.

Observation:

  • A 66-year-old male presented with a mediastinal mass.
  • Initial diagnosis and management were for pulmonary tuberculosis.
  • Histopathology revealed chronic necrotizing granulomatous inflammation.

Findings:

  • The patient later developed cytoplasmic antineutrophil cytoplasmic antibodies (c-ANCA)-associated granuloma.
  • Significant renal impairment was noted.
  • Symptoms improved with immunosuppressive therapy.

Implications:

  • GPA should be considered in patients with mediastinal masses.
  • Early differentiation from infections like tuberculosis is crucial.
  • c-ANCA testing aids in diagnosing GPA in complex cases.
Keywords:
anca vasculitisanti-tuberculous therapygranulomatosis with polyangiitismycophenolate mofetiltuberculosis

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