A Case of Wegener's Granulomatosis Simulating Lung Cancer and Treatment with Plasmapheresis

Abstract

Wegener's Granulomatosis (WG) is a rare disease characterized by granulomatous vasculitis of the upper and lower respiratory tract, kidneys and other organs. Herein, we present a case analyzed with an initial diagnosis of metastatic lung cancer, but later, as the patient was diagnosed with WG, she was treated with plasmapheresis. A 62-year-old female was admitted with fatigue, cough, dyspnea and hemoptysis. She was examined in a hospital specialized in chest diseases with initial diagnosis of metastatic lung cancer due to her symptoms for the last six months; she was referred to our clinic due to uremia. On physical examination, the patient had tachypnea, orthopnea, pretibial edema and diffuse rales to the upper lung zones. Laboratory tests revealed urea of 211 mg/dl and creatinine of 6.3 mg/dl, besides leukocytosis and anemia. Based on the chest X-ray, which demonstrated nodular cavitating lesions, and on positive c-ANCA, the patient was diagnosed with WG and immunosuppressive treatment together with plasmapheresis was applied. The clinical and radiological findings resolved completely. Pulmonary involvement of WG is usually in the form of bilateral, cavitating, solitary nodule or mass with smooth borders, and may be confused with lung cancer, as in our case. The presence of alveolar hemorrhage increases mortality up to 50%. High-dose immunosuppressive therapy together with plasmapheresis may be lifesaving in these patients.