Chronic Febrile Respiratory Illness with Acino-nodular Consolidations as Presenting Feature of Granulomatosis with Polyangiitis

Abstract

Pulmonary tuberculosis (TB) is the most common cause for chronic febrile respiratory illness with constitutional symptoms in India being endemic and more prevalent in the nature of disease. Acino-nodular consolidations are documented in infective, inflammatory, autoimmune, and systemic vasculitis with pulmonary involvement. Pulmonary manifestations of systemic vasculitis have very diverse involvement ranging from nodule, consolidation, and cavitation. In this case report, a 40-year male, presented with constitutional symptoms such as persistent fever, anorexia, and minimal dry cough lung parenchymal consolidations. Patients' symptoms progressed over 4 months with poor response to empirical anti-TB treatment without mycobacterial microscopic or genome documentation in sputum. Bronchoscopy workups were inconclusive and tropical screens for bacterial, fungal, TB, and malignancy were negative. Clinical-radiological worsening and acinonodular masses with cavitation guide us to work for vasculitis panel and documented proteinase 3-antineutrophil cytoplasmic antibody positive with very highly raised titers. We have started on steroids with cyclophosphamide and observed excellent clinical and radiological response in 24 weeks.

Progressive Primary Pulmonary Tuberculosis in Current Times: Are we really heading Towards ‘End of TB’ or Still, Many Miles to go for ‘Dream Come True’?

“…Final outcome in delayed treatment initiation may lead to destroyed lung as post tuberculosis sequel and proportionate number of cases may have lung function abnormalities irrespective of radiological outcome [18][19][20]. Tuberculosis may be misdiagnosed due to confusing or overlapping clinical and radiological features in high burden setting like India [21][22][23][24]. In present case report we have reported advanced pulmonary tuberculosis with delayed diagnosis due to lack of awareness in patient, accompanying relatives and care takers and family physicians to symptoms, available diagnostic modalities and universally acceptable and freely available treatment options for tuberculosis as per NTEP program in India.…”

Hydroxychloroquine as ‘Potential Treatment Option’ for Persistent Immune Dysregulation in Long COVID: Revisiting Its New Use as a ‘Versatile’ Molecule!

“…During COVID-19 pandemic antigenic cross reactivity has documented with dengue fever [10][11][12][13]. Similarly, deregulated immune phenomenon has been documented after covid vaccination and transient autoimmune features have been reported in various studies [14][15]. COVID-19 related extrapulmonary manifestations have been reported secondary to dysregulated immune response and systemic effects on immunity & immunosuppression resulting into tuberculosis [16], central nervous system resulting into stroke [17] and endocrinal effects resulting into hyponatremia [18].…”