SHM Converge Scientific Abstract ePoster Gallery-Not Just Otitis: Ent Clues for Granulomatosis With Polyangitis Masquerading as Metastatic Lung Disease

Pdf Summary

This case describes a 75-year-old woman with new-onset atrial fibrillation, syncope, dyspnea, night sweats, and decreased appetite who was found to have multiple bilateral pulmonary nodules, some cavitary, initially interpreted as possible metastatic lung disease. Her history was notable for one year of treatment-refractory bilateral otitis media and progressive hearing loss, which had been extensively evaluated by ENT. Initial laboratory testing showed mild neutrophilic leukocytosis, elevated ESR and CRP, and negative infectious and malignancy workup, including negative pleural fluid cytology. Autoimmune testing revealed weakly positive c-ANCA and markedly elevated PR3, raising concern for granulomatosis with polyangiitis (GPA).<br /><br />Because renal findings were absent, kidney biopsy was not pursued. The patient was started on high-dose prednisone. Definitive diagnosis was made by VATS lung biopsy, which showed necrotizing granulomas consistent with GPA.<br /><br />The presentation emphasizes that ENT-predominant GPA is often under-recognized and may be misattributed to chronic infection, age-related hearing loss, or structural ENT disease. Common ENT manifestations include recurrent sinusitis, nasal crusting, epistaxis, otitis media, mastoiditis, and progressive conductive or sensorineural hearing loss. In this case, diagnostic delay was worsened by anchoring on chronic otitis and by the radiologic appearance of cavitary lung nodules suggesting metastases, especially given the patient’s smoking history.<br /><br />Key teaching points are that refractory ENT disease should prompt consideration of GPA, and that multiple cavitary lung nodules warrant evaluation for GPA alongside infection and malignancy. Early ANCA/PR3 testing, rheumatology involvement, and timely biopsy can reduce delay and prevent irreversible complications such as hearing loss, pulmonary damage, and renal failure.

Asset Subtitle

Yusra Abu Shreikh

Meta Tag

Author List Bridget Hottenstein, James M. Parra II, Yusra Abu Shreikh

Category Clinical Vignettes

Concept Granulomatosis with Polyangiitis

Concept Tissue Biopsy

Concept Otitis Media

Concept Sinus Disease

Concept Hearing Loss

Distinguished Non-Finalist

Presenter Organization Roger William Medical Center

Presenting Author Yusra Abu Shreikh

Track Adult

Keywords

granulomatosis with polyangiitis

GPA

c-ANCA

PR3

cavitary pulmonary nodules

otitis media

hearing loss

vasculitis

lung biopsy

atrial fibrillation

Granulomatosis with Polyangiitis

Tissue Biopsy

Otitis Media

Sinus Disease

Hearing Loss