Granulomatosis with polyangitis with mononeuritis multiplex-immunosuppressives playing a double-edged sword.
A 52-year-old female was diagnosed with rheumatoid arthritis and was on methotrexate and prednisolone. She developed fever, cough, hemoptysis, and cavitary lesion on chest skiagram. She was put on antitubercular therapy without any improvement, meanwhile she developed painful right foot drop. Clinicoradiology and C-ANCA study confirmed the diagnosis of granulomatosis with polyangitis (GPA). She was started on cyclophosphamide, corticosteroid, and co-trimoxazole. While her treatment was being continued she showed significant improvement of pulmonary manifestations. About 1 year later, there was reappearance of fever, cough, and radiological opacity with oropharyngeal candidiasis. She became very ill with disseminated intravascular coagulation (DIC)-like features. Immunological markers were negative but bronchoalveolar lavage fluid study showed growth of Aspergillus spp. The patient was promptly put on intravenous voriconazole but unfortunately she succumbed to her illness.
Department of Respiratory Medicine, College of Medicine and Sagar Dutta Medical College and Hospital, Kamarhati, Kolkata, West Bengal, India.
Subhasis
S
Mukherjee
Department of Respiratory Medicine, College of Medicine and Sagar Dutta Medical College and Hospital, Kamarhati, Kolkata, West Bengal, India.
Debabani
D
Biswas
Department of Anatomy, North Bengal Medical College and Hospital, Siliguri, West Bengal, India.
Shabana
S
Begum
Department of Respiratory Medicine, College of Medicine and Sagar Dutta Medical College and Hospital, Kamarhati, Kolkata, West Bengal, India.
Pulakesh
P
Bhanja
Department of Respiratory Medicine, College of Medicine and Sagar Dutta Medical College and Hospital, Kamarhati, Kolkata, West Bengal, India.
Amartya Kumar
AK
Misra
Department of General Medicine, College of Medicine and Sagar Dutta Medical College and Hospital, Kamarhati, Kolkata, West Bengal, India.
Partha
P
Chatterjee
Granulomatosis with polyangitis; immunosuppressants; lung; mononeuritis multiplex