Wegener granulomatosis: case report and brief literature review.

Case Report The patient was a 42-year-old white man with a history of sinusitis for almost 2 years. He was treated with different antibiotics as an outpatient without any improvement. He developed a lung mass on chest radiograph, so he was referred to the surgical service for biopsy. On the day of the planned biopsy, the patient was febrile with an elevated white blood cell count (WBC). He also had severe headache; therefore, biopsy was canceled and the patient was transferred to the Family Practice team. At admission, his temperature was 98.8°F, pulse was 90 beats/min, respiratory rate was 20 breaths/ min, blood pressure was 150/90 mm Hg, and his weight was 217 pounds. He was not in severe distress. Tympanic membranes were clear with positive light reflexes. His throat was erythematous and without other lesions. His neck was supple with no meningeal signs. His lungs were clear to auscultation bilaterally. His abdomen was neither tender nor distended. There was no edema, cyanosis, or clubbing of his extremities. Computerized tomography (CT) of his sinuses showed mucosal thickening in all sinuses, including sphenoid, frontal, ethmoidal, and maxillary (Fig. 1). Laboratory studies included: WBC, 12.2 10/ L; hemoglobin, 12.3 g/dL; hematocrit, 0.345; platelets, 271 10/ L; serum urea nitrogen, 21 mg/dL; creatinine, 0.9 mg/ dL; aspartate aminotransferase, 39 U/L; alanine aminotransferase, 129 U/L; alkaline phosphatase, 91 U/L. The admission diagnosis was pansinusitis that had failed outpatient treatment and a lung mass. The patient was started on 500 mg/day levofloxacin administered intravenously. Magnetic resonance imaging of brain ruled out possible cavernous sinus thrombosis. CT of the chest showed a large, dominant, left upper lobe lesion abutting the pleura with two smaller noncalcified lesions in the left and right upper lobes; this was interpreted as suspicious for carcinoma of the lung (Figs. 2 and 3). CT of his abdomen and pelvis were negative. Tumor markers ( -fetoprotein, prostate-specific antigen) were also negative. Submitted, revised, 10 March 2003. From the Departments of Family Medicine (KS, EL), Nephrology (MA), and Pathology (JG), Louisiana State University Health Science Center, E. A. Conway Medical Center, Monroe, and Department of Pathology, Louisiana State University Health Science Center, Shreveport (MF). Address correspondence to Khaled Shafiei, MD, Department of Family Medicine, E. A. Conway Medical Center, 4864 Jackson St, Monroe, LA 71210 (e-mail: kshafiei@ hotmail.com). Figure 1. Focus of granulomatous inflammation, lung (hematoxylin and eosin; original magnification, 400 ).