Figure 2: Computed Tomography (CT) chest showing dense consolidation of
the entire right lung and peripheral infiltrates in the left lung.
To confirm the diagnosis, a Video-assisted thoracoscopic surgery
(VATS)-guided lung biopsy was performed, showing characteristic
histological features of ANCA-associated vasculitis, including fibrin
and blood filling the alveolar space, inflammatory infiltrate with
neutrophils, scattered areas of necrosis, endothelial damage, and
necrotizing vasculitis as shown in Figure 3 and Figure 4. Despite the
absence of well-formed granulomata, the findings supported the diagnosis
of GPA. Treatment with methylprednisolone and rituximab led to medical
stabilization, although the patient experienced complications of
subcutaneous emphysema and progressive lower extremity neuropathic
symptoms.
Following successful stabilization, the patient was discharged home with
a walker due to foot drop and was scheduled for outpatient neurology and
rheumatology follow-up.