A Case of Granulomatosis with Polyangiitis with Rapidly Growing Lung Nodules Diagnosed by a Transbronchial Lung Biopsy

• Published in: The Journal of the Japan Society for Respiratory Endoscopy Vol. 43; no. 4; pp. 404 - 410
• Main Authors: Nakayama, Emi, Kitamura, Tomotaka, Hamada, Eriko, Maekura, Toshiya, Nakamura, Takahito
• Format: Journal Article
• Language: Japanese
• Published: The Japan Society for Respiratory Endoscopy 25.07.2021
• Subjects: Granulomatosis with polyangiitis; Multiple lung masses; Rapidly growing lung nodules; Transbronchial lung biopsy
• ISSN: 0287-2137; 2186-0149
• DOI: 10.18907/jjsre.43.4_404

Background. The characteristic pathological findings of granulomatosis with polyangiitis (GPA) are difficult to obtain by a transbronchial lung biopsy (TBLB). Case. A 76-year-old man underwent annual chest computed tomography (CT) to evaluate pleural thickening, and an incidental finding of several lung nodules in both lung fields was detected. Contrast CT performed three days later revealed that the nodules and masses had increased in size. Initially, the lesions were suspected of being infectious; therefore, the patient was admitted, and antibiotic therapy was initiated. However, the lung nodules and masses grew rapidly, and a TBLB was performed at the right B3b on day 4 of admission. Blood tests results showed that the proteinase 3 anti-neutrophil cytoplasmic antibody (PR3-ANCA) level was 48.4 U/ml on day 6 of admission. The histopathological results of the TBLB specimen were available on day 7 of admission and showed characteristic pathological findings of GPA, including geographic necrosis, small-vessel vasculitis, and multiple granulomas. The renal function was normal, and paranasal CT revealed lateral sinusitis with bone destruction, indicating GPA. Therefore, the diagnosis of localized GPA was established. Intravenous cyclophosphamide (750 mg/body) was administered on day 8 of admission, and oral prednisolone (70 mg/day) was initiated on day 9 of admission. Conclusion. This case was diagnosed as GPA based on the TBLB results, as a TBLB was performed in the active phase. To diagnose GPA via a TBLB, the timing of this procedure is extremely important. A TBLB can aid in the diagnosis of GPA in the active phase.