Relapsing ANCA-associated vasculitis presenting as a mediastinal mass

Area of Science:

• Nephrology
• Rheumatology
• Oncology

Background:

• Anti-neutrophil cytoplasmic antibody-associated vasculitides (AAV) are multisystem disorders characterized by small vessel inflammation and pauci-immune glomerulonephritis.
• Delayed diagnosis and treatment of AAV can lead to irreversible renal damage.
• AAV relapses can mimic infections or malignancy, complicating patient management.

Purpose of the Study:

• To present a case of a rare anterior mediastinal mass as a complication of myeloperoxidase-positive vasculitis.
• To underscore the diagnostic challenges in AAV, particularly when symptoms are vague or mimic other conditions.
• To emphasize the importance of multimodality imaging and a multidisciplinary approach in managing AAV.

Main Methods:

• Case report of a young male with pre-existing myeloperoxidase-positive vasculitis.
• Clinical presentation with subacute symptoms.
• Diagnostic workup including exclusion of other etiologies and tissue sampling.
• Multimodality imaging.

Main Results:

• Anterior mediastinal mass identified as a complication of vasculitis.
• Prompt immunosuppression escalation initiated after diagnosis.
• Tissue sampling excluded alternative diagnoses like infection or malignancy.

Conclusions:

• Mediastinal masses can be a rare complication of AAV.
• Diagnostic challenges in AAV necessitate a high index of suspicion and comprehensive evaluation.
• Multidisciplinary collaboration and advanced imaging are crucial for timely and accurate AAV diagnosis and management.