RT Book, Section A1 Kermani, Tanaz A. A1 Warrington, Kenneth J. A2 Dean, Steven M. A2 Satiani, Bhagwan A2 Abraham, William T. SR Print(0) ID 1105292359 T1 GRANULOMATOSIS WITH POLYANGIITIS (WEGENER) T2 Color Atlas and Synopsis of Vascular Diseases YR 2015 FD 2015 PB McGraw-Hill Medical PP New York, NY SN 9780071749541 LK accesssurgery.mhmedical.com/content.aspx?aid=1105292359 RD 2024/10/10 AB A 32-year-old man presented with a 3-month history of fever, weight loss, sinusitis, arthralgias, and dyspnea. He had been treated with several courses of antibiotics for presumed sinusitis with no improvement. Computed tomography (CT) of the chest to evaluate his dyspnea showed multiple cavitary, pulmonary nodules (Figure 78-1). He was a lifetime nonsmoker and denied risk factors for tuberculosis. Bronchoalveolar lavage with bacterial, fungal, and mycobacterial stains and cultures were all negative. Transbronchial biopsy showed nonspecific inflammation and was negative for malignancy. Laboratory evaluation revealed anemia, elevated sedimentation rate, elevated C-reactive protein (CRP), and acute kidney injury (creatinine [1.9 mg/dL]). Urinalysis showed microscopic hematuria, red blood cell casts, and proteinuria. A renal biopsy was pursued and showed a pauci-immune, necrotizing glomerulonephritis (Figure 78-2). Antineutrophil cytoplasmic antibody (ANCA) testing was positive for a cytoplasmic staining pattern (c-ANCA) with specificity to proteinase-3 (PR3). A diagnosis of granulomatosis with polyangiitis (GPA, Wegener) was made. The patient was treated with high doses of glucocorticoids and oral cyclophosphamide with successful induction of remission. Six months later, he was transitioned to azathioprine.