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Oh, Jeong, Kim, Son, Ban, Lim, Cho, Ju, Kim, Kim, Lim, and Kim: A Case of Wegener's Granulomatosis that Presented as a Single Lung Mass
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2007; 63(1): 88-93.

Published online: 31 July 2007

DOI: https://doi.org/10.4046/trd.2007.63.1.88

A Case of Wegener's Granulomatosis that Presented as a Single Lung Mass

In Jae Oh, M.D., Jong Pil Jeong, M.D., Soo Ok Kim, M.D., Jun Gwang Son, M.D., Hee Jung Ban, M.D., Jung Hwan Lim, M.D., Gye Jung Cho, M.D., Jin Young Ju, M.D., Kyu Sik Kim, M.D., Yu Il Kim, M.D., Sung Chul Lim, M.D., Young Chul Kim, M.D.

Department of Internal Medicine, Chonnam National University, Medical School, Gwangju, Korea.

Address for correspondence: Kyu Sik Kim, M.D. Lung and Esophageal Cancer Clinic, Chonnam National University Medical School and Hwasun Hospital, 160 Ilsim-ri, Hwasun-gun, Jeonnam, 519-809, Korea. Phone: 82-61-379-7615, FAX: 82-61-379-7628, cyberkks@chonnam.ac.kr

Received 5 April 2007       Accepted 11 June 2007

Copyright © 2007 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

Wegener's granulomatosis is a disease with an unknown etiology that is characterized by necrotizing granulomatous vasculitis involving the upper and lower respiratory tract and the kidneys. The typical pulmonary findings are bilaterally involved multiple variable sized nodules.
We report a case of Wegener's granulomatosis that presented as a single lung mass. A male patient presented with a nasal obstruction, arthralgia, cough, and intermittent dyspnea. The chest radiograph showed a mass, approximately 4.5 cm in diameter, in the right lower lobe. Lung cancer or tuberculosis was initially considered. However, the clinical, laboratory and pathological findings of the mass indicated Wegener's granulomatosis. The patient was administered prednisolone and cyclophosphamide, and improved temporarily. Unfortunately, the immunocompromised patient expired as a result of respiratory failure with pneumonia.

Keywords: Wegener's granulomatosis, Single lung mass, Opportunistic infection

Figures and Tables

Figure 1
(A) An initial chest X-ray showed a soft tissue mass, approximately 4.5 cm in diameter, in the right lower lung field. (B) Water's view showed mucosal thickening of both maxillary sinuses.
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Figure 2
(A) The chest CT showed a 4.5cm-sized nodular lesion in the posterobasal segment of the right lower lobe. (B) A CT-guided transthoracic core needle biopsy for that nodule was performed in the prone position.
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Figure 3
Multiple, variable sized purpuras were developed on both lower legs and both feet.
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Figure 4
The microscopic findings of the resected pulmonary mass showed (A) a granuloma and (B) necrotizing vasculitis (H&E stain, ×100). These inflammatory lesions were positive in immunohistochemical stains for (C) CD 34 and (D) elastin (immunohistochemical stain, ×200).
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Figure 5
(A) A follow up chest X-ray showed increased size of the cavitary lesion in the right lower lung, with multifocal ill-defined opacities in both lungs. The chest CT showed (B) markedly increased size of the previously noted irregular cavitary mass in the right lower lobe and (C) increased sizes and numbers of multiple nodules with ground glass opacity halos in both upper lobes.
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