Tuberc Respir Dis.  2007 Jul;63(1):88-93. 10.4046/trd.2007.63.1.88.

A Case of Wegener's Granulomatosis that Presented as a Single Lung Mass

• Oh IJ
• Jeong JP
• Kim SO
• Son JG
• Ban HJ
• Lim JH
• Cho GJ
• Ju JY
• Kim KS
• Kim YI
• Lim SC
• Kim YC

• KMID: 1877323
• DOI: http://doi.org/10.4046/trd.2007.63.1.88

Abstract

Wegener's granulomatosis is a disease with an unknown etiology that is characterized by necrotizing granulomatous vasculitis involving the upper and lower respiratory tract and the kidneys. The typical pulmonary findings are bilaterally involved multiple variable sized nodules. We report a case of Wegener's granulomatosis that presented as a single lung mass. A male patient presented with a nasal obstruction, arthralgia, cough, and intermittent dyspnea. The chest radiograph showed a mass, approximately 4.5 cm in diameter, in the right lower lobe. Lung cancer or tuberculosis was initially considered. However, the clinical, laboratory and pathological findings of the mass indicated Wegener's granulomatosis. The patient was administered prednisolone and cyclophosphamide, and improved temporarily. Unfortunately, the immunocompromised patient expired as a result of respiratory failure with pneumonia.

Keyword

Wegener's granulomatosis; Single lung mass; Opportunistic infection

MeSH Terms

Arthralgia
Cough
Cyclophosphamide
Dyspnea
Humans
Immunocompromised Host
Kidney
Lung Neoplasms
Lung*
Male
Nasal Obstruction
Opportunistic Infections
Pneumonia
Prednisolone
Radiography, Thoracic
Respiratory Insufficiency
Respiratory System
Tuberculosis
Vasculitis
Wegener Granulomatosis*
Cyclophosphamide
Prednisolone

Figure

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  Figure 1 (A) An initial chest X-ray showed a soft tissue mass, approximately 4.5 cm in diameter, in the right lower lung field. (B) Water's view showed mucosal thickening of both maxillary sinuses.

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  Figure 2 (A) The chest CT showed a 4.5cm-sized nodular lesion in the posterobasal segment of the right lower lobe. (B) A CT-guided transthoracic core needle biopsy for that nodule was performed in the prone position.

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  Figure 3 Multiple, variable sized purpuras were developed on both lower legs and both feet.

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  Figure 4 The microscopic findings of the resected pulmonary mass showed (A) a granuloma and (B) necrotizing vasculitis (H&E stain, ×100). These inflammatory lesions were positive in immunohistochemical stains for (C) CD 34 and (D) elastin (immunohistochemical stain, ×200).

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  Figure 5 (A) A follow up chest X-ray showed increased size of the cavitary lesion in the right lower lung, with multifocal ill-defined opacities in both lungs. The chest CT showed (B) markedly increased size of the previously noted irregular cavitary mass in the right lower lobe and (C) increased sizes and numbers of multiple nodules with ground glass opacity halos in both upper lobes.

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