Localized, ANCA-Negative, Granulomatosis With Polyangiitis Presenting as Isolated Pulmonary Lesions

Abstract

Clinical Images TextA 52-year-old woman with history of incomplete systemic lupus erythematosus (SLE) presented with worsening shortness of breath after being evaluated 10 days before an urgent care for cough and shortness of breath without hemoptysis. Her cough resolved, but increased shortness of breath brought her to the emergency department.The patient's D-dimer level was elevated at 809 ng/mL with subsequent chest computed tomography angiogram negative for pulmonary embolus. Computed tomography (CT) findings were significant for multiple pulmonary nodules with some demonstrating air bronchograms, and others demonstrating circumferential halos suggesting active infectious process (Fig. 1A-D). Her vitals were within normal limits, and other laboratory values were notable for normal white blood cell count, normal serum creatinine and urinalysis, microcytic anemia with hemoglobin of 8.1 g/dL, elevation in erythrocyte sedimentation rate to 78 mm/h, and Creactive protein level of 0.5 mg/dL, positive rheumatoid factor of 85 IU/mL, ANA titer of 1:2560 in a homogenous and nucleolar pattern, and anti-DNA titer of 1:160. Results of SS-A/SS-B testing were greater than 8.0 AI. The patient was discharged from the emergency department with a 4-week course of augmentin with plans to repeat chest CT upon completion of antibiotic course and outpatient rheumatology follow-up.At rheumatology appointment, SLE serologies were obtained due to family history of SLE in her mother and 2 sisters. sources relevant to the topic.