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
- Aberle DR, Gamsu G, Lynch D. Thoracic manifestations of Wegener granulomatosis: diagnosis and course. Radiology. 174, 703-709 (1994). http://dx.doi.org/10.1148/radiology.174.3.2305053
- Brauner MW, Grenier P, Mompoint D, et al. Pulmonary sarcoidosis: evaluation with high-resolution CT. Radiology. 467-471 (1989). http://dx.doi.org/10.1148/radiology.172.2.2748828
- Castañer E, Alguersuari A, Gallardo X, et al. When to suspect pulmonary vasculitis: radiologic and clinical clues. Radiographics. 30(1), 33-53 (2010). http://dx.doi.org/10.1148/rg.301095103
- Hours S, Nunes H, Kambouchner M, et al. Pulmonary cavitary sarcoidosis: clinic-radiologic characteristics and natural history of a rare form of sarcoidosis. Medicine. 87(3), 142-51 (2008). http://dx.doi.org/10.1097/md.0b013e3181775a73
- Gadkowski LB, Stout JE. Cavitary Pulmonary Disease. Clin Microbiol Rev. 21(2), 305-333 (2004). http://dx.doi.org/10.1128/cmr.00060-07
- Mahr A, Batteux F, Tubiana S, et al. Brief report: Prevalence of antineutrophil cytoplasmic antibodies in infective endocarditis. Arthritis Rheum. 66(6), 1672-7 (2014). http://dx.doi.org/10.1002/art.38389
- Makol A, Crowson CS, Wettler DA, et al. Vasculitis associated with rheumatoid arthritis: a case-control study. Rheumatology. 53(5), 89-9 (2014). http://dx.doi.org/10.1093/rheumatology/ket475
- Ozkaya S, Bilgin S, Hamsici S, Findik S. The pulmonary radiologic findings of rheumatoid arthritis. Respiratory Medicine. 4(4), 187-192 (2011). http://dx.doi.org/10.1016/j.rmedc.2011.03.003
- Radice A, Bianchi L, Sinico RA. Anti-neutrophil cytoplasmic autoantibodies: methodologic aspects and clinical significance in systemic vasculitis. Autoimmun Rev. 12(4), 487-95 (2013). http://dx.doi.org/10.1016/j.autrev.2012.08.008
- Seo P, Stone JH. The antineutrophil cytoplasmic antibody-associated vasculitides. Am J Med. 117, 39-50 (2004). http://dx.doi.org/10.1016/j.amjmed.2004.02.030
- Webb WR, Gamsu G. Cavitary pulmonary nodules with systemic lupus erythematosus: differential diagnosis. Am J Roentgenol. 136, 27-31 (1981). http://dx.doi.org/10.2214/ajr.136.1.27
- 12. Wiesner O, Russell KA, Lee AS, et al. Antineutrophil cytoplasmic antibodies reacting with human neutrophil elastase as a diagnostic marker for cocaine-induced midline destructive lesions but not autoimmune vasculitis. Arthritis Rheum. 50(9), 2954-65 (2004). http://dx.doi.org/10.1002/art.20479
Cite this Article:
International Journal of Sciences is Open Access Journal.
This article is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) License.
Author(s) retain the copyrights of this article, though, publication rights are with Alkhaer Publications.