Cavitary Lung Lesions, Rash, Systemic Shock, Hematuria, and Acute Kidney Injury in a patient with Elevated Anti-Nuclear Antibody Titers and Rheumatoid Factor

Author(s): Mehret Birru Talabi, Douglas Lienesch, Kimberly Liang

We present a case of a 42 year-old male with history of complicated gastric bypass and recent deep vein thrombosis who presented with purpuric rash, systemic shock, and cavitary lung lesions, and leukocytosis, acute kidney injury, and elevated RF, anti-nuclear antibody titer, and inflammatory markers. Initial presentation was concerning for systemic vasculitis. Aspiration pneumonia with resultant lung abscesses was ultimately diagnosed. No corticosteroids or immunosuppression were initiated at any point during the management of the patient, and he improved with antibiotics and drainage of the abscesses. Cavitary lung lesions are rare in rheumatic diseases, which helped to narrow the differential diagnosis. Mimics of vasculitis include malignancy and infection, and often pose a diagnostic and therapeutic challenge.

Vasculitis, Cavitary Lung Lesion, Leukocytoclastic Vasculitis, Pigmented Purpuric Dermatosis

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