A 49-Year-Old Woman Presenting With Cavitary Lung Lesions: A Case Report

Granulomatosis with polyangiitis (GPA) can be a challenging diagnosis to confirm due to significant overlap with other small-vessel vasculitis syndromes and similar presentations to non-vasculitic processes such as infection or malignancy. We report a case of a 49-year-old woman presenting with several months of cough, chest wall pain, and weight loss, who was found to have several cavitary lung lesions on imaging, no renal involvement, and unusual anti-neutrophil cytoplasmic antibody (ANCA) serologies. After tissue biopsy, the patient was diagnosed with GPA and treated with steroids and rituximab with clinical improvement at follow-up. Due to a complex clinical course and non-classic symptomatology, her diagnosis of GPA was not discovered until several months after symptom onset. Clinicians should consider GPA in the case of progressive cavitary lung lesions even in the absence of renal involvement or positive ANCA serologies, as prompt tissue diagnosis is crucial to allow for early initiation of treatment.