B35-38 Isolated Pulmonary Granulomatosis With Polyangiitis Mimicking Pneumonia
Abstract
Granulomatosis with polyangiitis (GPA) is a rare ANCA-associated vasculitis with a prevalence of 1–2 cases per 100,000 person-years. While classically involving the upper airways, lungs, and kidneys, GPA can occasionally present as isolated pulmonary disease. Such presentations often mimic infectious or organizing pneumonias, leading to delayed diagnosis and treatment. This case highlights the importance of considering vasculitis in patients with subacute, treatment-resistant pneumonia, an essential diagnostic awareness for clinicians.
A 29-year-old previously healthy male presented with three weeks of progressive dyspnea, cough, and fever. He was diagnosed with community-acquired pneumonia and treated sequentially with amoxicillin/clavulanate, azithromycin, and levofloxacin without improvement. Imaging revealed bilateral nodular consolidations with extensive ground-glass opacities on CT. Despite broad-spectrum antibiotics (vancomycin and cefepime), he developed worsening hypoxemia requiring high-flow nasal cannula and ICU admission. Infectious workup was negative, including bacterial, fungal, and viral studies. Laboratory evaluation showed elevated inflammatory markers, rheumatoid factor of 142 IU/mL, anti-CCP 7 units, and positive c-ANCA (1:160) with anti–PR3 antibodies. Bronchoalveolar lavage plus transbronchial biopsies demonstrated hemosiderin-laden macrophages consistent with diffuse alveolar hemorrhage. Intravenous methylprednisolone (250 mg daily) was initiated for…
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