Case Report

Positive C-ANCA and Cavitary Lung Lesion: Recurrence of Wegener Granulomatosis or Aspergillosis?

Authors: Bobbak Vahid, MD, Bernadette Wildemore, MD, Christopher Nguyen, MD, Paul Marik, MD

Abstract

A case of a cavitary lung lesion in the right middle lobe of a 34-year-old woman who presented with hemoptysis is presented. The patient had a 2-year history of Wegener granulomatosis that had been treated with cyclophosphamide and corticosteroids. Although the patient gradually achieved remission of her disease, she developed new pulmonary symptoms and a cavitary lesion in her right lung. Further workup revealed elevated C- and P-ANCA titers. Following partial resection of her right lung, she was found to have an aspergilloma and no evidence of active Wegener granulomatosis. Pulmonary aspergillosis was felt to be the cause of both the hemoptysis and the cavitary lesion. We postulate that C-ANCA and P-ANCA were falsely positive in this case. Although rare, false positive C-ANCA and P-ANCA have been reported in pulmonary fungal infections.


Key Points


* Pulmonary aspergillosis should be included in the differential diagnosis of patients on immunosuppressive therapy that present with new pulmonary lesions.


* False-positive C-ANCA may be seen in immunosuppressed patients with pulmonary aspergillosis.


* Positive C-ANCA with concurrently positive P-ANCA or negative anti-PR3 antibodies should alert the clinicians to consider alternative diagnoses other than recurrent vasculitis.


* Although further studies are necessary, the galatomannan ELISA assay could be potentially useful to differentiate between invasive aspergillosis and recurrent vasculitis.

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