Granulomatosis with polyangiitis - pulmonary

Case contributed by Dr Ian Bickle

Presentation

Intermittent haematuria and haemoptysis. No arthralgia. Anti-MPO and Anti-PR3 postive.

Patient Data

Age: 60 years
Gender: Male

Multiple focal areas of consolidation in both lungs measuring upto 2cm, most of which are subpleural in location.  Several are wedge shaped and have a small amount of surrounding groundglass opacification.

Minor right apical bronchiectasis.

No endobronchial lesion.

No mediastinal lymphadenopathy.

Right upper lobe subpleural 1.4cm lesion targeted.

20G core biopsy x 2 taken.

The patient has haemoptysis immediately after the biopsy. Several clots (1-3mls).

3mm post procedural pneumothorax.

 

Pathology

Lung biopsy histology

LUNG BIOPSY RESULT:  Granulomatous inflammation with polyangiitis

Case Discussion

Granulomatosis with polyangiitis (GPA) is a multisystem necrotising non-caseating granulomatous vasculitis involving the small to medium-sized arteries, capillaries and veins. It most commonly affects the respiratory system and kidneys as in this case.

This patient also had laboratory evidence of renal impairment and a renal biopsy identified concurrent renal involvement.

Four types of pulmonary involvement are recognised as one of which is typified by peripheral wedge-like consolidation. as illustrated in this case.

The post lung biopsy haemoptysis self-resolved.   Immunosuppressive treatment was commenced.

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Case information

rID: 61561
Published: 12th Jul 2018
Last edited: 12th Jul 2018
System: Chest
Tag: ripas2
Inclusion in quiz mode: Included

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