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Abstract
Wegener's granulomatosis (WG) classically consists of necrotizing granulomatous inflammation of the upper and/or lower respiratory tract, necrotizing glomerulonephritis, and an autoimmune necrotizing systemic vasculitis affecting predominantly small vessels. We report a case of WG with central nervous system (CNS) involvement. WG is being diagnosed through pulmonary nodule biopsy. A small nodular lesion in the left posterior basal ganglia of brain being highly suspicious for granulomatosis was detected by MRI. After IV pulse cyclophosphamide and oral corticosteroid treatment for over 4 months, clinical manifestations and CNS lesions in brain MRI is improved. WG might have multiple granulomatous lesions which could be misdiagnosed due to malignancy. CNS involvement in WG is rare but careful evaluation is necessary when there are suspicious symptoms or lesions in CNS.
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Figure 1.
Chest X ray (PA and lateral view) shows nodular opa-cities and cavitary lesions in both upper lung fields and patchy opa-cities in both lower lung fields.
Figure 2.
Chest CT shows multiple cavities and nodules in both lung fields and focal consolidation is also noted in upper right lobe.
Figure 3.
Hematoxylin and eosin stain of a lung nodule. Tissue obtained from VATS biopsy showed giant cells (black arrow) and necrotizing granulomatous vasculitis (white arrow).
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