CRA85 A CASE REPORT ON GRANULOMATOSIS WITH POLYANGIITIS PRESENTING AS BILATERAL NECROTIZING PNEUMONIA

¹Nurul Aimi Abd Ghani, ¹Irfhan Ali Hyder Ali, ¹Lalitha Pereirasamy, ²Lee Fong Wan

¹Respiratory Department, Hospital Pulau Pinang, ²Pathology Department Hospital Pulau Pinang, Penang, Malaysia

INTRODUCTION
Granulomatosis with polyangiitis (GPA), formerly known as Wegener’s granulomatosis, is a rare systemic vasculitis affecting medium and small blood vessels. Common symptoms include upper and lower respiratory issues and renal involvement, with potential effects on other organs. Most patients are positive for C-ANCA antibodies. Upper respiratory manifestations may include oral ulcers and nasal deformities, while lower respiratory symptoms often involve cough, hemoptysis, and dyspnea. Radiological findings might show cavitary lung nodules and ground-glass opacities. Sometimes, atypical presentations complicate diagnosis, as seen in a case we encountered.

CASE PRESENTATION
We report a 53-year-old woman with no significant medical history who presented with prolonged high-grade fever, cough, and weight loss. Initially diagnosed and treated for necrotizing pneumonia, her chest radiograph showed right middle zone consolidation. A CT scan revealed bilateral lung mass like-consolidations and suspicious lesions in her right kidney, spleen, and liver. All cultures returned negative results, though urine analysis indicated proteinuria. Despite multiple antibiotics, the fever persisted. A CT-guided lung biopsy revealed vasculitis with necrotizing granulomatous inflammation, and serological tests for ANCA and anti-PR3 were positive. She was treated with high-dose corticosteroids, leading to the resolution of her fever.

DISCUSSION
GPA usually presents with respiratory symptoms, making diagnosis challenging because its radiological features can overlap with other conditions. In this case, the initial pneumonia diagnosis was corrected after thorough investigations revealed GPA. Delays in treatment can have serious consequences, highlighting the importance of careful patient monitoring.

CONCLUSION
GPA can mimic necrotizing pneumonia radiologically, necessitating comprehensive evaluations for patients with persistent symptoms to rule out systemic diseases.