Coexistence of Pulmonary Thromboembolism, Pulmonary Tuberculosis and Granulomatosis with Polyangiitis: A flimsy triple dribble

Abstract

Granulomatosis with polyangiitis (GPA) is a rare autoimmune disease with multi‐system involvement. It involves the upper respiratory tract, lungs and kidneys. A 36-year-old female patient presented with complaints of low-grade fever, dry cough and loss of appetite initially followed by dyspnea, purpuric skin lesions, right lower limb swelling with pain and redness. Her chest radiograph revealed right upper lobe cavitary lesion with consolidation in right lower lobe. Mycobacterium tuberculosis was detected in sputum and Broncho alveolar lavage (BAL) via Cartridge based nucleic acid amplification assay (CB-NAAT). Later, Computed Tomography Pulmonary Angiography (CTPA) revealed bilateral pulmonary artery thromboembolism. Furthermore, her C-ANCA was positive, serum creatinine was rising, urine microscopy had red cell casts and lower limb venous doppler revealed DVT. Histopathological examination of the skin lesion revealed vasculitis. Based on the above findings, diagnosis of GPA was comfortably made. Patient improved with pulse steroids, cyclophosphamide, anticoagulants and anti-tuberculous therapy (ATT).

Keywords: Granulomatosis with polyangiitis (GPA), Pulmonary Tuberculosis, Pulmonary thrombo-embolism, deep venous thrombosis, vasculitis, c-ANCA.