Beware of the master masquerader- A case series of cavitary lung disease with hearing loss

Abstract

Granulomatosis with polyangiitis (GPA) is an etiologically unknown systemic disease characterized by necrotizing granulomatous inflammation. Additionally, it is accompanied by vasculitis of small and medium-sized blood vessels. It manifests clinically as a triad involving the lungs, upper airways, and kidneys. It is estimated that 90% of patients will exhibit upper or lower airway symptoms and around 80% develops the renal disease. In this article, we describe three case scenarios with varying presentations. GPA should be considered among the possible etiologies of cavitary pulmonary lesions with ear manifestations including hearing loss with poor response to unusual treatment.

Keywords: Cavitary lung disease; diagnostic dilemma; granulomatosis with polyangiitis; hearing loss; hemoptysis.

Figure 1

Chest X-ray (PA view) showing cavity in right upper and lower zone (a), CT-Thorax showing thick-walled cavity in right lower lobe (c); Pure Tone audiogram (d) mild sensorineural hearing loss (SNHL) in right ear and severe mixed hearing loss with profound loss at high frequency in left ear, and (b) showing response to treatment

Figure 2

Chest Radiograph (PA view) showing multiple cavitary nodules involving bilateral mid and lower zone (a), CT-Thorax showing multiple cavitary nodules with left sided pleural effusion (b), and (c) shows resolution of cavities and pleural effusion after 3 months of treatment initiation

Figure 3

Chest Radiograph (PA view) showing bilateral cavitary nodules with left sided effusion (a) and CT brain (b) shows features of CSOM (White arrow denoting hypopneumatisation of the mastoid air cells)