SHM Converge Scientific Abstract ePoster Gallery-A Rare Case of Granulomatous Polyangiitis With Limited Renal Involvement

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This case report describes a 56-year-old man diagnosed with granulomatosis with polyangiitis (GPA), a rare necrotizing granulomatous vasculitis of small to medium vessels that most often affects the upper airways, lungs, and kidneys. The patient presented with worsening headaches, fevers, chills, malaise, and major weight loss after a recently treated dental abscess. He also had lymphadenopathy and elevated inflammatory markers, but initial basic labs and urinalysis were largely normal.<br /><br />Further evaluation showed positive ANCA with c-ANCA titer 1:40 and elevated proteinase 3 antibodies, supporting GPA. Infectious workup, including blood cultures and testing for fungal and other infections, was negative. Brain MRI showed acute sinusitis, chest X-ray showed bilateral consolidative opacities, and chest CT revealed multiple cavitary pulmonary nodules. Biopsies and bronchoscopy found chronic granulomatous inflammation and necrotizing inflammatory changes, with no evidence of malignancy, tuberculosis, or fungal disease.<br /><br />The patient was diagnosed with GPA and started on ampicillin/sulbactam, prednisone, methotrexate, and folic acid, with clinical improvement.<br /><br />The report emphasizes that this was a case of “limited GPA,” meaning disease predominantly involved the respiratory tract with only minimal renal involvement. Although the patient had microscopic hematuria, he had no proteinuria, red blood cell casts, or impaired kidney function. The authors highlight that limited GPA may be misdiagnosed because it does not always present with the classic triad of upper airway, lung, and kidney disease. Early recognition is important because prompt immunosuppressive treatment improves outcomes.

Asset Subtitle

Sara Hassan

Meta Tag

Author List Keir F. MacKay, Margaret Beliveau, Nosher Ali, Sara Hassan, Waseem Ahmad

Category Clinical Vignettes

Concept Granulomatosis with Polyangiitis

Concept Renal Disease

Concept Antineutrophil cytoplasmic antibody

Concept Biopsy

Concept Upper Respiratory Tract

Distinguished Non-Finalist

Presenter Organization Ocean University Medical Center

Presenting Author Sara Hassan

Track Adult

Keywords

granulomatosis with polyangiitis

GPA

c-ANCA

proteinase 3 antibodies

necrotizing granulomatous vasculitis

cavitary pulmonary nodules

sinusitis

limited GPA

methotrexate

prednisone

Granulomatosis with Polyangiitis

Renal Disease

Antineutrophil cytoplasmic antibody

Biopsy

Upper Respiratory Tract