CASE REPORT
Cavitating lung disease is not always due to tuberculosis! Wegener’s granulomatosis with mycetoma with deep vein thrombosis lower limb: Case report with review of literature
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1
MIMSR Medical College, Latur, Maharashtra, INDIA
2
Venkatesh Chest Hospital and Critical Care Center, Latur, Maharashtra, INDIA
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NIMS Medical College, Jaipur, Rajasthan, INDIA
Online publication date: 2022-10-25
Publication date: 2023-01-01
Electron J Gen Med 2023;20(1):em425
KEYWORDS
ABSTRACT
Pulmonary tuberculosis is most common cause for bilateral pulmonary cavities with constitutional symptoms in India being endemic and more prevalent nature of disease, irrespective of microscopy or nucleic acid amplification test abnormalities. Pulmonary manifestations of systemic vasculitis have very diverse involvement ranging from nodule, consolidation, and cavitation. In this case report, 49-year female, presented with constitutional symptoms with lung parenchymal consolidations progressed to cavitation’s and started empirical anti-tuberculosis treatment without mycobacterial microscopic or genome documentation in sputum with clinical or radiological worsening. Bronchoscopy workup is inconclusive and tropical screen for bacterial, TB, and malignancy were negative and fungal yield aspergillus colonization. Vasculitis workup done in presence of clinical and radiological worsening documented PR3-ANCA positive with very highly raised titers. We have started on steroids, cyclophosphamide with antifungals and clinical response documented with near complete resolution of shadows in 24 weeks. She had developed DVT (deep vein thrombosis) lower limb during course of illness and documented excellent response to anticoagulation. DVT prophylaxis is must in all cases taking steroids with decreased daily activities to prevent fatal cardiovascular complications.
REFERENCES (9)
2.
Lohrmann C, Uhl M, Kotter E, Burger D, Ghanem N, Langer M. Pulmonary manifestations of Wegener granulomatosis: CT findings in 57 patients and a review of the literature. Eur J Radiol. 2005;53:471-7.
https://doi.org/10.1016/j.ejra... PMid:15741022.
3.
Wegener F. Über eine eigenartige rhinogene granulomatose mit besonderer beteilgung des arteriensytems und den nieren [About a peculiar rhinogenic granulomatosis with special involvement of the arterial system and the kidneys]. Beitr Pathol Anat Allg Pathol. 1939;102:36-68.
4.
Thickett DR, Richter AG, Nathani N, Perkins GD, Harper L. Pulmonary manifestations of anti-neutrophil cytoplasmic antibody (ANCA)-positive vasculitis. Rheumatology. 2006;45:261-8.
https://doi.org/10.1093/rheuma... PMid:16418204.
5.
Armstrong P, Wilson AG, Dee P, Hansell DM. Imaging of diseases of the chest, 3rd ed. London, UK: Mosby International Limited, 2000.
6.
Kim Y, Lee KS, Jung KJ, Han J, Kim JS, Suh JS. Halo sign on high-resolution CT: Findings in spectrum of pulmonary diseases with pathologic correlation. J Comput Assist Tomogr. 1999;23:622-6.
https://doi.org/10.1097/000047... PMid:10433297.
7.
Farrelly CA. Wegener’s granulomatosis: A radiological review of the pulmonary manifestations at initial presentation and during relapse. Clin Radiol. 1982;33:545-51.
https://doi.org/10.1016/S0009-....