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Mauricio Danckers, Fang Zhou, Diana Nimeh, H. Michael Belmont, David J. Steiger
(Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York University Langone Medical Center, New York, NY, USA)
Am J Case Rep 2015; 16:287-291
Granulomatosis with polyangiitis (GPA) relapse can complicate the differential diagnosis of pulmonary lesions.
Case Report: A 70-year-old male smoker with GPA and emphysema presented with dyspnea, dry cough, and a right upper lobe pulmonary ground-glass opacity that persisted despite antibiotics. A trans-bronchial biopsy did not reveal active vasculitis, malignancy, or infection. He was treated for presumed GPA relapse based on pulmonary manifestations, renal failure, and elevated PR3-ANCA. Later, hematuria led to the cystoscopic discovery of a bladder wall lesion, which was diagnosed as micropapillary urothelial carcinoma not involving the muscularis propria. The patient developed an increasing pulmonary infiltrate with a new solid component, satellite lesions, and regional lymphadenopathy. A right upper lobe wedge resection showed metastatic urothelial carcinoma.
Conclusions: The simultaneous presentation of a pulmonary lesion and GPA relapse is a diagnostic challenge. The differential diagnosis should include the rare possibility of metastatic urothelial carcinoma, regardless of how the lesion appears radiographically.