Non-resolving pneumonia revealing ANCA vasculitis.

Area of Science:

• Internal Medicine
• Rheumatology
• Pulmonology

Background:

• Pneumonia can present with non-resolving symptoms, necessitating a broader differential diagnosis.
• Granulomatosis with polyangiitis (GPA) is a rare systemic vasculitis that can affect multiple organs, including the lungs.
• Pulmonary infarction, a potential complication of thromboembolism, can mimic infectious pneumonia.

Purpose of the Study:

• To present a case of granulomatosis with polyangiitis (GPA) initially misdiagnosed as community-acquired pneumonia.
• To emphasize the importance of considering rare diagnoses and diagnostic clues in non-resolving pneumonia.
• To illustrate the effective management of GPA with oral glucocorticoids.

Main Methods:

• A comprehensive diagnostic workup was performed for a patient with persistent pneumonia symptoms.
• Diagnostic investigations included laboratory tests (anemia, neutrophilic leukocytosis, elevated D-dimer and CRP, positive c-ANCA) and radiological imaging.
• The patient was treated with oral glucocorticoids, and clinical, biochemical, and radiological outcomes were monitored.

Main Results:

• The patient, a farmer with diabetes and heart failure, presented with a 1-month history of non-resolving pneumonia.
• Diagnostic workup revealed granulomatosis with polyangiitis (GPA), characterized by anemia, neutrophilic leukocytosis, acute kidney injury, elevated inflammatory markers, and a positive cytoplasmic anti-neutrophil cytoplasmic antibody (c-ANCA).
• Following a 4-week course of oral glucocorticoids, the patient demonstrated significant clinical, biochemical, and radiological improvement.

Conclusions:

• Granulomatosis with polyangiitis (GPA) can present atypically, mimicking common conditions like pneumonia.
• Pulmonary infarction, a sign of embolism, should be considered in patients with risk factors and may present as a Hampton's hump.
• This case underscores the critical role of recognizing rare disease presentations, utilizing diagnostic clues, and implementing appropriate management strategies for vasculitis.