Lata Sampatrao Rajwad, Ketaki Vasudev Utpat, Unnati Deepak Desai, Jyotsna Madanmohan Joshi

Granulomatosis with polyangiitis (GPA), formerly known as Wegener's granulomatosis, is a rare form of vasculitis. It targets small-sized blood vessels and causes inflammation and damage to blood vessels most commonly in the nose, sinuses, ears, lungs and kidneys. It is an autoimmune disorder with unknown cause. It may present with upper and lower respiratory lesions, renal failure, cranial neuropathies, ocular inflammation, and cutaneous vasculitis. Patients with pulmonary affection present with respiratory signs and symptoms, including cough, haemoptysis, and dyspnoea. Haemorrhage, cavitary lesions in the lungs, and pulmonary fibrosis are the customary lung manifestations. We hereby narrate a rare case of a patient presenting to us with respiratory symptoms and a chest radiograph suggestive of non-resolving consolidation. A 59 years old man was referred to our department for symptoms of cough with mucoid expectoration associated with streaky haemoptysis, intermittent fever and exertional dyspnoea of Modified Medical Research Council (MMRC) grade 1 since 6 months. He was a non-smoker with no past history of Pulmonary Tuberculosis (PTB). He had comorbidity in form of Diabetes mellitus (DM). Before visiting our hospital, he was evaluated with a chest radiograph (CXR) suggestive of left lower zone cavity with consolidation. He was diagnosed as community acquired pneumonia (CAP) and was treated with oral and injectable antibiotics with no relief of symptoms and hence had followed up to our side. His general examination was normal, on Respiratory System examination breath sounds were reduced on right lower chest. The diagnosis was clinched on transbronchial lung biopsy histopathological examination showing a necrotising granulomatous inflammation with vasculitis.