Clinical Review Lesson of the week

Pulmonary Wegener's granulomatosis misdiagnosed as malignancy

BMJ 2001; 322 doi: (Published 13 January 2001) Cite this as: BMJ 2001;322:89
  1. S Uppal, senior house officera,
  2. N Saravanappa, senior house officera,
  3. J P Davis, consultanta (,
  4. C K T Farmer, senior registrarb,
  5. D J A Goldsmith, consultantb
  1. a Department of Otorhinolaryngology and Head and Neck Surgery, Medway Maritime Hospital, Gillingham, Kent ME7 5NY
  2. b Renal Unit, Guy's Hospital, London SE1 9RT
  1. Correspondence to: J P Davis
  • Accepted 15 March 2000

Cytoplasmic antineutrophil cytoplasmic antibody tests can prevent misdiagnosis of Wegener's granulomatosis as malignancy

Wegener's granulomatosis is a systemic vasculitis that primarily involves the upper and lower respiratory tracts and kidneys. Pulmonary Wegener's granulomatosis can present with multifocal lung involvement or solitary lung lesions with no evidence of extrapulmonary disease.1 Diagnosing Wegener's granulomatosis on the basis of cytological material obtained from fine needle aspiration or sputum may present a challenging problem to the pathologist. A wrong diagnosis may lead to inappropriate treatment for the patient. We describe two patients with Wegener's granulomatosis originally diagnosed as malignancy.

Case reports

Case 1

A 70 year old woman presented with an 18 month history of intermittent productive cough and pain of the left lower chest. Clinical examination of the chest gave normal results. A chest x ray film showed a hazy left base with loss of radiological markings of the left hemidiaphragm and left heart border. A computed tomogram showed three nodules within the lungs: one at the right apex, one in the apical segment of the left lower lobe, and one in the posterobasal segment of the right lower lobe. The nodules were non-enhancing and had irregular margins. Fibreoptic bronchoscopy gave normal results. Bronchial washings showed no acid fast bacilli or malignant cells. Fine needle aspiration of the lesion in the right lower lobe …

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