Non-resolving pneumonia revealing ANCA vasculitis

A farmer in his mid-60s with diabetes mellitus and heart failure on medications presented with non-resolving pneumonia for the past 1 month. The patient was initially treated for community-acquired pneumonia but was referred to us when there was no resolution of symptoms. The patient had anaemia, neutrophilic leucocytosis, acute kidney injury, raised D-dimer and C-reactive protein, and a positive cytoplasmic anti-neutrophil cytoplasmic antibody. After an extensive workup, a diagnosis of granulomatosis with polyangiitis was made. The patient was treated with oral glucocorticoids for 4 weeks. On follow-up, the patient showed drastic improvement clinically, biochemically and radiologically. Pulmonary infarction can mimic pneumonia and should be considered in patients having risk factors for embolism. A peripheral wedge-shaped opacity (Hampton's hump) is often a classical sign of pulmonary infarction. Thus, this case emphasises the importance of rare presentation, diagnostic clues and management strategies.