A Case of Granulomatosis with Polyangiitis with Rapidly Growing Lung Nodules Diagnosed by a Transbronchial Lung Biopsy

DOI
  • Nakayama Emi
    Department of Respiratory Medicine, Japan Community Healthcare Organization Hoshigaoka Medical Center
  • Kitamura Tomotaka
    Department of Pathogen, Infection and Immunity, Nara Medical University
  • Hamada Eriko
    Department of Respiratory Medicine, Japan Community Healthcare Organization Hoshigaoka Medical Center
  • Maekura Toshiya
    Department of Respiratory Medicine, Japan Community Healthcare Organization Hoshigaoka Medical Center
  • Nakamura Takahito
    Department of Respiratory Medicine, Japan Community Healthcare Organization Hoshigaoka Medical Center

Bibliographic Information

Other Title
  • 多発肺結節・腫瘤の急速増大を認め経気管支肺生検により診断し得た多発血管炎性肉芽腫症の1例

Search this article

Description

<p>Background. The characteristic pathological findings of granulomatosis with polyangiitis (GPA) are difficult to obtain by a transbronchial lung biopsy (TBLB). Case. A 76-year-old man underwent annual chest computed tomography (CT) to evaluate pleural thickening, and an incidental finding of several lung nodules in both lung fields was detected. Contrast CT performed three days later revealed that the nodules and masses had increased in size. Initially, the lesions were suspected of being infectious; therefore, the patient was admitted, and antibiotic therapy was initiated. However, the lung nodules and masses grew rapidly, and a TBLB was performed at the right B3b on day 4 of admission. Blood tests results showed that the proteinase 3 anti-neutrophil cytoplasmic antibody (PR3-ANCA) level was 48.4 U/ml on day 6 of admission. The histopathological results of the TBLB specimen were available on day 7 of admission and showed characteristic pathological findings of GPA, including geographic necrosis, small-vessel vasculitis, and multiple granulomas. The renal function was normal, and paranasal CT revealed lateral sinusitis with bone destruction, indicating GPA. Therefore, the diagnosis of localized GPA was established. Intravenous cyclophosphamide (750 mg/body) was administered on day 8 of admission, and oral prednisolone (70 mg/day) was initiated on day 9 of admission. Conclusion. This case was diagnosed as GPA based on the TBLB results, as a TBLB was performed in the active phase. To diagnose GPA via a TBLB, the timing of this procedure is extremely important. A TBLB can aid in the diagnosis of GPA in the active phase.</p>

Journal

Keywords

Details 詳細情報について

Report a problem

Back to top