SHM Converge Scientific Abstract ePoster Gallery-Seronegative Granulomatosis With Polyangiitis With Isolated Lung Lesions

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This case report describes a 54-year-old woman evaluated for hemoptysis and abnormal chest imaging. She had a history of bronchitis, a light prior smoking history, and occupational exposure as an electrician. Laboratory testing was notable for negative ANCA and ANA, but positive QuantiFERON. Chest CT showed multiple bilateral pulmonary nodules, some cavitary, including 13 mm and 15 mm lesions in the upper lungs. Biopsy of a right lower lobe nodule showed chronic inflammation with geographic necrosis, and surgical wedge resection of left lung lesions revealed necrotizing granulomatous inflammation, supporting a diagnosis of granulomatosis with polyangiitis (GPA).<br /><br />The report emphasizes that although GPA is typically associated with PR3-ANCA positivity, it can occur in seronegative form. Using American College of Rheumatology criteria, the patient met diagnostic requirements through abnormal chest imaging and biopsy findings. Importantly, she had limited disease confined to the lungs, without renal involvement.<br /><br />She was treated with rituximab weekly for one month and then monthly for six months. Follow-up CT four weeks after treatment showed no new lesions and reduction or resolution of existing nodules, indicating a good response.<br /><br />The main message is that ANCA-negative patients with cavitary pulmonary nodules should still be evaluated for GPA. Early recognition is crucial because untreated GPA has high mortality, while limited disease diagnosed early has a much better prognosis.

Asset Subtitle

Sinduja Sivakumar

Meta Tag

Author List Aditya v. Sambandam, Dhiran Sivasubramanian, Harkesh Arora, Sinduja Sivakumar

Category Clinical Vignettes

Concept Granulomatosis with Polyangiitis

Concept Cavitary Pulmonary Nodule

Concept Necrotizing Granulomatous Inflammation

Concept Pulmonary Lesion

Concept Antineutrophil cytoplasmic antibody

Distinguished Non-Finalist

Presenter Organization Burrell College of Osteopathic Medicine

Presenting Author Sinduja Sivakumar

Track Adult

Keywords

granulomatosis with polyangiitis

ANCA-negative

cavitary pulmonary nodules

hemoptysis

necrotizing granulomatous inflammation

chest CT

rituximab

seronegative vasculitis

lung biopsy

limited pulmonary disease

Granulomatosis with Polyangiitis

Cavitary Pulmonary Nodule

Necrotizing Granulomatous Inflammation

Pulmonary Lesion

Antineutrophil cytoplasmic antibody