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Case Reports
. 2021 Apr 6;9(10):2344-2351.
doi: 10.12998/wjcc.v9.i10.2344.

Granulomatosis with polyangiitis presenting as high fever with diffuse alveolar hemorrhage and otitis media: A case report

Xiao-Jie Li  1 , Liu Yang  1 , Xiao-Feng Yan  1 , Chu-Ting Zhan  1 , Jiang-Hua Liu  1
Affiliations
Case Reports

Granulomatosis with polyangiitis presenting as high fever with diffuse alveolar hemorrhage and otitis media: A case report

Xiao-Jie Li et al. World J Clin Cases. .

Abstract

Background: Granulomatosis with polyangiitis is a necrotizing inflammation of small and medium-sized vessels accompanied by formation of granuloma, involvement of primary granulomatous upper and lower respiratory tracts, glomerulonephritis, and vasculitis of small vessels.

Case summary: Herein, we described a case of a 52-year-old man admitted with pulmonary nodules and high fever. Autoantibody workup revealed that the patient was positive for c-anti-neutrophil cytoplasmic antibodies and proteinase-3 anti-neutrophil cytoplasmic antibodies. Pulmonary biopsies revealed a local granulomatous structure. The patient received therapy with methylprednisolone and intravenous immunoglobulin, and his clinical symptoms improved.

Conclusion: Intravenous immunoglobulin may act on granulomatosis with polyangiitis similar to immunosuppressants.

Keywords: Case report; Diffuse alveolar hemorrhage; Granulomatosis with polyangiitis; Intravenous immunoglobulin; Methylprednisolone; Otitis media.

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Conflict of interest statement

Conflict-of-interest statement: All authors have no conflicts of interest.

Figures

Figure 1
Figure 1
Chest computed tomography scan at admission. A: Multiple masses and nodules were found in both lungs; B: Multiple consolidation in both lungs; C: No obvious enhancement was found in the nodules; D: Hilar and mediastinal lymphadenopathy.
Figure 2
Figure 2
Imaging changes in the lung after anti-tuberculosis treatment. A: The pulmonary nodules were larger than before treatment; B: The lung shadow was greater than before treatment.
Figure 3
Figure 3
Results of bronchoscopic biopsy. A: Biopsies revealed local granulomatous structure; peripheral fibrous hyperplasia; lymphocyte, plasma cell and neutrophil infiltration (Papanicolaou stain, 20 ×); B: By microscopy, columnar epithelial cells and individual lymphocytes were seen, and no heterotypic cells were found (hematoxylin and eosin stain, 20 ×).
Figure 4
Figure 4
Chest computed tomography scan re-examination at the last follow-up on May 6, 2020. A: There were strip shadows in both lungs; B: No obvious shadow or nodules were found in both lungs.
See this image and copyright information in PMC

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