AN UNUSUAL CAUSE OF RECURRENT PNEUMONIAS

TOPIC: Pulmonary Manifestations of Systemic Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Granulomatosis with polyangiitis (GPA) is a necrotizing small vessel vasculitis classically involving the upper and lower respiratory tract kidneys. We present patient GPA which initially presented as "recurrent pneumonias" unresponsive to antibiotics ultimately culminating in presentation alveolar hemorrhage failure. CASE PRESENTATION: A 70-year-old man Emergency Department dyspnea hemoptysis. He had been hospitalized several times over preceding month for recurrent pneumonia, recently started on systemic anticoagulation pulmonary embolism. On arrival he was afebrile, tachycardic, hypoxemic tachypneic. Exam revealed coarse bilateral breath sounds. Laboratory studies were significant anemia, leukocytosis, acutely elevated creatinine microscopic hematuria. CT Chest showed diffuse consolidation ground glass opacities markedly worse than 1 week prior. initiated broad spectrum admitted ICU. The intubated progressive failure hemoptysis; bronchoalveolar lavage demonstrated progressively bloody return. C-ANCA PR3 antibodies positive; infectious evaluation other autoimmune serologies negative. presumptive diagnosis ANCA associated made treatment methylprednisolone 1,000 mg daily then transitioned prednisone mg/kg after 3 days. Renal biopsy confirmed GPA; rituximab added rapid improvement. DISCUSSION: variable manifestations, ranging from asymptomatic disease Specific manifestations include tracheobronchial stenosis, inflammatory lesions, interstitial lung disease, (DAH). Image findings nodules or without cavitation, consolidation. Delayed common, necessitating high index suspicion. Involvement disruption capillaries leads hemorrhage, early bronchoscopy can facilitate identification DAH, exclusion potential etiologies, lead treatment. Induction therapy severe GPA, defined life organ threatening includes dose intravenous corticosteroids combination cyclophosphamide rituximab. While DAH may be life-threatening complication most patients achieve remission survive hospital discharge. CONCLUSIONS: Severe presentations non-specific, setting persistent symptoms accelerate initiation saving REFERENCE #1: Chung MP, Yi CA, Lee HY, Han J, KS. Imaging Vasculitis. Radiology. 2010;255(2):322-341. doi:10.1148/radiol.10090105 #2: Polychronopoulos VS, Prakash UBS, Golbin JM, Edell ES, Specks U. Airway Wegener's Granulomatosis. Rheumatic Clinics North America. 2007;33(4):755-775. doi:10.1016/j.rdc.2007.09.004 #3: Cartin-Ceba R, Diaz-Caballero L, Al-Qadi MO, et al. Diffuse Alveolar Hemorrhage Secondary Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: Predictors Respiratory Failure Clinical Outcomes. Arthritis & Rheumatology. 2016;68(6):1467-1476. doi:10.1002/art.39562 DISCLOSURES: No relevant relationships by Scott Canepa, source=Web Response Bryan Kelly, Alexander Niven,