Granulomatosis with polyangiitis with obstructive pneumonia progressing to hypertrophic pachymeningitis A case report
Rationale: </br> Bronchial involvement alone is a rare initial manifestation of granulomatosis with polyangiitis (GPA). Herein, we report a case of refractory GPA with obstructive pneumonia caused by bronchial involvement.</br> Patient concerns: </br> A 65-year-old man complained of a 2-week cough and fever.</br> Diagnoses: </br> Considering the presence of opacities and multiple consolidations in both lungs due to obstruction or stenosis on the bronchus, which did not respond to antibiotics, and proteinase-3-antineutrophil cytoplasmic autoantibody positivity, he was diagnosed with GPA. Positron emission tomography- computed tomography scan revealed no abnormal findings in the upper respiratory tract.</br> Interventions: </br> He was treated with prednisolone (PSL, 50 mg/d) and intravenous cyclophosphamide.</br> Outcomes: </br> His general and respiratory symptoms improved. However, 8 weeks after PSL treatment at 20 mg/d, he developed a relapse of vasculitis along with sinusitis and hypertrophic pachymeningitis. Hence, PSL treatment was resumed to 50 mg/d, and weekly administration of rituximab was initiated. Consequently, the symptoms gradually mitigated.</br> Lessons: </br> GPA with bronchial involvement is often intractable and requires careful follow-up, which should include upper respiratory tract and hypertrophic pachymeningitis assessment.
Medicine 100 (3), e24028-, 2021-01-22
Lippincott, Williams & Wilkins