Chinese PLA General Hospital, Beijing, China
Copyright 2016, American College of Chest Physicians. All Rights Reserved.
SESSION TITLE: Pulmonary Manifestations of Systemic Disease
SESSION TYPE: Case Report Slide
PRESENTED ON: Saturday, April 16, 2016 at 09:45 AM - 11:15 AM
INTRODUCTION: Wegener granulomatosis (WG) is a rare systemic and necrotizing small-sized vessel vasculitis, associated with antineutrophil cytoplasm antibodies (ANCA) and cyclophosphamide and methylprednisolone may be the effective therapy, which may lead to the complications of tuberculosis or fungal infection, etc. In the case, a man was diagnosis with WG, complicated with TB infection after receiving cyclophosphamide and methylprednisolone for almost one year.
CASE PRESENTATION: Granulomatosis with polyangiitis (Wegener) (GPA) was diagnosed in a 37 year-old-man who had a diagnosis with multiple nodular high density shadow in double lobe and “air crescent” sign on chest CT and the pathology of left lung showed chronic inflammation with lymphocytic vasculitis and peripheral inflammation, alveolar epithelial cell proliferation. CT scan showed relapse high density shadow and air crescent after the patients were treated with cyclophosphamide and methylprednisolone for almost one year. The patient had no symptoms such as cough and chest pain. Auxiliary examination indicated ANCA was negative. However, TB-SPOT was positive. The left lung biopsies revealed caseous granulomas and a large number of acid fast bacilli by acid fast staining. After given anti-tuberculosis treatment for six months, the patient improved.
DISCUSSION: Wegener granulomatosis (WG) is a rare systemic and necrotizing small-sized-vessel vasculitis, associated with antineutrophil cytoplasm antibodies (ANCA), mainly directed against proteinase 3 (PR3). In addition to its typical clinical triade of ear, nose and throat, pulmonary and renal involvements. Most of these latter were caused by local granulomatous tissue infiltration and their responses to conventional treatment for WG varied widely. Cyclophosphamide and methylprednisolone are the typical treatment for the disease, which may lead to TB infections because of immunosuppression. Because TB and GPA have similar findings including both clinical and anti-proteinase 3 antibodies. Histological findings of tuberculosis (TB) and TB-SPOT are useful for the diagosis of TB when the treatment with corticotherapy completed with cyclophosphamid do noteffective for clinical, biological and radiological improvement.
CONCLUSIONS: For patients with long-term application of hormone and immunosuppressive agents, improve the vigilance of secondary pulmonary tuberculosis infection.
Reference #1: Martinez-Martinez MU, Gomez-Gomez A, Oros-Ovalle C, Abud-Mendoza C. A male patient with cavitary pulmonary disease. Reumatologia clinica. 2013;9(1):62-4.
Reference #2: Barreto P, Pagnoux C, Luca L, Aouizerate J, Ortigueira I, Cohen P, et al. Dorsal prevertebral lesions in Wegener granulomatosis: report on four cases. Joint, bone, spine: revue du rhumatisme. 2011;78(1):88-91.
DISCLOSURE: The following authors have nothing to disclose: Duchao Zhang, Lixin Xie
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