Granulomatous Disorder With Pulmonary and Renal Involvement:: A Diagnostic and Therapeutic Dilemma

Merina Khan; Nida Saleem; Syed Nayer Mahmud; Hadia Bukhari

doi:10.7759/cureus.23149

Granulomatous Disorder With Pulmonary and Renal Involvement: A Diagnostic and Therapeutic Dilemma

Merina Khan, Nida Saleem, Syed Nayer Mahmud, Hadia Bukhari

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Abstract

Granulomatosis with polyangiitis (GPA) can present with a wide array of clinical signs and symptoms; therefore, it should be differentiated from other mimicking clinicopathological entities. We report a case of a 66-year-old gentleman who was found to have a mediastinal mass and histopathological examination showed chronic necrotizing granulomatous inflammation. The patient was managed on lines of pulmonary tuberculosis for 12 months and remained in remission for two years. Later, workup showed cytoplasmic antineutrophil cytoplasmic antibodies (c-ANCA)-associated granuloma with marked renal impairment, which responded to immunosuppression. From this, we suggest that in a patient with radiological evidence of mediastinal mass, the remote possibility of GPA must be kept in mind.

Original language	English
Article number	e23149
Number of pages	5
Journal	The Cureus Journal of Medical Science
Volume	14
Issue number	3
DOIs	https://doi.org/10.7759/cureus.23149
Publication status	Published - 14 Mar 2022
Externally published	Yes

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

anti-tuberculous therapy
anca vasculitis
Mycophenolate mofetil
tuberculosis
granulomatosis with polyangiitis

Access to Document

10.7759/cureus.23149Licence: CC BY

Published versionFinal published version, 726 KBLicence: CC BY

Cite this

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title = "Granulomatous Disorder With Pulmonary and Renal Involvement:: A Diagnostic and Therapeutic Dilemma",

abstract = "Granulomatosis with polyangiitis (GPA) can present with a wide array of clinical signs and symptoms; therefore, it should be differentiated from other mimicking clinicopathological entities. We report a case of a 66-year-old gentleman who was found to have a mediastinal mass and histopathological examination showed chronic necrotizing granulomatous inflammation. The patient was managed on lines of pulmonary tuberculosis for 12 months and remained in remission for two years. Later, workup showed cytoplasmic antineutrophil cytoplasmic antibodies (c-ANCA)-associated granuloma with marked renal impairment, which responded to immunosuppression. From this, we suggest that in a patient with radiological evidence of mediastinal mass, the remote possibility of GPA must be kept in mind.",

keywords = "anti-tuberculous therapy, anca vasculitis, Mycophenolate mofetil, tuberculosis, granulomatosis with polyangiitis",

author = "Merina Khan and Nida Saleem and Mahmud, {Syed Nayer} and Hadia Bukhari",

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T1 - Granulomatous Disorder With Pulmonary and Renal Involvement:

T2 - A Diagnostic and Therapeutic Dilemma

AU - Khan, Merina

AU - Saleem, Nida

AU - Mahmud, Syed Nayer

AU - Bukhari, Hadia

PY - 2022/3/14

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AB - Granulomatosis with polyangiitis (GPA) can present with a wide array of clinical signs and symptoms; therefore, it should be differentiated from other mimicking clinicopathological entities. We report a case of a 66-year-old gentleman who was found to have a mediastinal mass and histopathological examination showed chronic necrotizing granulomatous inflammation. The patient was managed on lines of pulmonary tuberculosis for 12 months and remained in remission for two years. Later, workup showed cytoplasmic antineutrophil cytoplasmic antibodies (c-ANCA)-associated granuloma with marked renal impairment, which responded to immunosuppression. From this, we suggest that in a patient with radiological evidence of mediastinal mass, the remote possibility of GPA must be kept in mind.

KW - anti-tuberculous therapy

KW - anca vasculitis

KW - Mycophenolate mofetil

KW - tuberculosis

KW - granulomatosis with polyangiitis

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