title: A surprise behind a case of winter vomiting virus.
abstract: A 79-year-old man was admitted through the medical take with norovirus gastritis. Routine plain chest radiography demonstrated a right coin lesion. CT and subsequent positron emission tomography showed a right upper lobe mass consistent with primary bronchial carcinoma. The lesion was resected and histology revealed a granulomatous necrotising mass without evidence of dysplasia. Meticulous investigations for infectious and non-infectious causes of necrotising granulomatous diseases were repeatedly negative. His postoperative recovery was complicated by a hospital-acquired pneumonia and a pulmonary embolism. CT pulmonary angiography showed progression of the previously resected mass and repeat biopsy was similar to the initial. A clinical diagnosis of antineutrophil cytoplasmic antibody-negative vasculitis without extrapulmonary manifestations was made and immunosuppressive therapy was initiated with rapid clinical response.
authors.affiliation: Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, Bath, UK. anopoulou@gmail.com
authors.forename: Aikaterini
authors.initials: A
authors.lastname: Panopoulou
authors.forename: Erin
authors.initials: E
authors.lastname: Vermaak
authors.forename: Neil
authors.initials: N
authors.lastname: McHugh
mesh_terms: D000368:Aged; D017250:Caliciviridae Infections / Q000150:complications*; D002283:Carcinoma, Bronchogenic / Q000175:diagnosis; D003937:Diagnosis, Differential; D005759:Gastroenteritis / Q000150:complications*; D014890:Granulomatosis with Polyangiitis / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D033162:Incidental Findings; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology; D008175:Lung Neoplasms / Q000175:diagnosis; D008297:Male; D029322:Norovirus; D011859:Radiography; D014839:Vomiting / Q000150:complications* / Q000209:etiology