Pulmonary Involvement in ANCA-associated Vasculitis Overlapping with Long-standing Systemic Lupus Erythematosus.
Yuki Kuwahara, Mizuki Nanri, Yuki Kurihara et al.
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Case in brief
A 74-year-old woman with long-standing systemic lupus erythematosus (SLE) presented with fever and bilateral centrilobular pulmonary nodules with bronchial wall thickening on computed tomography. She developed acute kidney injury, elevated antineutrophil cytoplasmic antibodies (ANCA), otitis media, and sinusitis, while anti-dsDNA and complement levels were normal. Lung histology showed necrotizing granuloma with vasculitis, supporting a diagnosis of granulomatosis with polyangiitis overlapping with SLE. She improved with glucocorticoids and rituximab.
What made this case unusual
ANCA-associated vasculitis emerged decades after SLE onset, with pulmonary nodules and bronchial wall thickening preceding renal and ear-nose-throat manifestations.
Diagnostic / clinical pearl
In a patient with SLE and new pulmonary or extrapulmonary findings—particularly renal dysfunction—consider ANCA-associated vasculitis; normal anti-dsDNA and complement levels may accompany this overlap.