Non-resolving pneumonia can be a sign of a rare disease known as granulomatosis with polyangiitis, a type of vasculitis, researchers from the University of Ottawa in Canada report.
A case study titled “An important cause of non-resolving pneumonia,” published in the journal Respiratory Medicine Case Reports, underscores the importance of considering this condition in patients where pneumonia is not getting better despite treatment.
Granulomatosis with polyangiitis — a condition earlier referred to as Wegener’s granulomatosis — is a disease where blood vessels throughout the body become inflamed. It is a type of vasculitis, and although the disease can cause inflammation throughout the entire body, the airways and organs such as eyes, kidneys, ears, throat, and skin are often affected.
The patient described in the report showed up at an outpatient clinic after coughing and feeling ill for two weeks. In addition, she had a rash on one of her palms, but did not have a fever or a runny nose, and did not experience other symptoms indicating infection.
Laboratory tests did at first not find any abnormalities, and a chest X-ray revealed changes that physicians interpreted as lobar pneumonia — inflammation of an entire lung lobe. Since lobar pneumonia is caused by the bacteria Streptococcus pneumoniae in most people, doctors sent the woman home with the antibacterial drug Avelox (moxifloxacin), advising her to take the medicine for 10 days.
When the women returned 10 days later, her cough was as bad as before the treatment, and physicians scanned the woman’s chest with a computed tomography (CT) method. The scan showed changes in both lungs, with a larger mass-like area in one lung and a couple of smaller affected areas in the other.
The woman was admitted to hospital, where further tests did not show any infection. She did, however, have increased levels of anti-cytoplasmic nuclear antibodies, making physicians suspect vasculitis, an idea that was supported by the CT scans.
Her clinical team took core needle biopsies to get a closer look at tissue in the affected areas. A pathologist who examined the tissue under the microscope saw it was inflamed and full of granulomas, or clumps of immune cells, as well as damaged tissue.
The analysis of the biopsy, along with previous findings, made the doctors conclude that the condition was a limited form of granulomatosis with polyangiitis. Limited forms of the disease are those not affecting the kidney, brain, or gut, but they can nevertheless be severe.
The woman was treated with high doses of prednisone and the immunosuppressant drug methotrexate, which allowed her to slowly improve.
