Chronic febrile respiratory illness with acino-nodular consolidations as presenting feature of granulomatosis with polyangiitis: A case report with review of literature

Pulmonary tuberculosis (TB) is the most common cause for chronic febrile respiratory illness with constitutional symptoms in India being endemic and more prevalent in the nature of disease. Acino-nodular consolidations are documented in infective, inflammatory, autoimmune, and systemic vasculitis with pulmonary involvement. Pulmonary manifestations of systemic vasculitis have very diverse involvement ranging from nodule, consolidation, and cavitation. In this case report, a 40-year male, presented with constitutional symptoms such as persistent fever, anorexia, and minimal dry cough lung parenchymal consolidations. Patients' symptoms progressed over 4 months with poor response to empirical anti-TB treatment without mycobacterial microscopic or genome documentation in sputum. Bronchoscopy workups were inconclusive and tropical screens for bacterial, fungal, TB, and malignancy were negative. Clinical-radiological worsening and acinonodular masses with cavitation guide us to work for vasculitis panel and documented proteinase 3-antineutrophil cytoplasmic antibody positive with very highly raised titers. We have started on steroids with cyclophosphamide and observed excellent clinical and radiological response in 24 weeks.