[A case of Wegener's granulomatosis which showed early spontaneous remission]

An 80-year-old woman presented at our hospital on October 1995 with fever, hemoptysis and a cavitary shadow on chest X-ray. Blood examination revealed an accelerated erythrocyte sedimentation ratio and elevated CRP. Pulmonary cryptococcosis was suspected, but serological tests and bronchoscopic examination for cryptococcus were both negative. There was also no evidence of the tuberculosis or malignancy. She was treated with the antibiotic cefpirome sulfate intravenously for thirteen days. Her chest X-ray and abnormal blood test findings became almost completely normal following the i.v. antibiotic treatment. In February 1996 (2 months after her first admission), she had severe right cheek pain, and Coldwell Luc's operation was performed after right maxillary sinusitis was diagnosed. A high fever (39 degrees C) continued after surgery, and multiple cavitary shadows were seen on chest X-ray. Blood examination revealed an accelerated ESR, elevated CRP and slightly elevated c-ANCA. She was treated with i.v. infusion of antibiotics and antifungal drug's, but did not improve. Wegener's granulomatosis was diagnosed after transcutaneous lung biopsy and histopathological examination of the maxillary sinus. Dramatic improvement was seen following treatment with oral cyclophosphamide and prednisolone. Whether her first remission was due to antibiotic treatment or spontaneous is an interesting question.