title: Pulmonary metastasis in a patient with simultaneous bladder cancer and relapsing granulomatosis with polyangiitis.
abstract: BACKGROUND
  Granulomatosis with polyangiitis (GPA) relapse can complicate the differential diagnosis of pulmonary lesions.
  
  
  METHODS
  A 70-year-old male smoker with GPA and emphysema presented with dyspnea, dry cough, and a right upper lobe pulmonary ground-glass opacity that persisted despite antibiotics. A trans-bronchial biopsy did not reveal active vasculitis, malignancy, or infection. He was treated for presumed GPA relapse based on pulmonary manifestations, renal failure, and elevated PR3-ANCA. Later, hematuria led to the cystoscopic discovery of a bladder wall lesion, which was diagnosed as micropapillary urothelial carcinoma not involving the muscularis propria. The patient developed an increasing pulmonary infiltrate with a new solid component, satellite lesions, and regional lymphadenopathy. A right upper lobe wedge resection showed metastatic urothelial carcinoma.
  
  
  CONCLUSIONS
  The simultaneous presentation of a pulmonary lesion and GPA relapse is a diagnostic challenge. The differential diagnosis should include the rare possibility of metastatic urothelial carcinoma, regardless of how the lesion appears radiographically.
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York University Langone Medical Center, New York, NY, USA.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Danckers
authors.affiliation: Department of Pathology, New York University Langone Medical Center, New York, NY, USA.
authors.forename: Fang
authors.initials: F
authors.lastname: Zhou
authors.affiliation: Department of Pathology, New York University Langone Medical Center, New York, NY, USA.
authors.forename: Diana
authors.initials: D
authors.lastname: Nimeh
authors.affiliation: Division of Rheumatology, Department of Medicine, New York University Langone Medical Center, New York, NY, USA.
authors.forename: H Michael
authors.initials: HM
authors.lastname: Belmont
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York University Langone Medical Center, New York, NY, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Steiger
mesh_terms: D000369:Aged, 80 and over; D001706:Biopsy; D001999:Bronchoscopy; D002295:Carcinoma, Transitional Cell / Q000150:complications / Q000175:diagnosis / Q000556:secondary*; D003558:Cystoscopy; D003937:Diagnosis, Differential; D014890:Granulomatosis with Polyangiitis / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000175:diagnosis / Q000556:secondary*; D008297:Male; D014057:Tomography, X-Ray Computed; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000473:pathology*