Delayed diagnosis of granulomatosis with polyangiitis presenting as irregularly shaped solid lung nodules with heterogeneous enhancement: A case report

Rationale: Granulomatosis with polyangiitis (GPA) is a systemic autoimmune vasculitis. Thoracic radiographic findings in GPA can mimic various pulmonary diseases, potentially leading to misdiagnosis. We describe a case of delayed GPA diagnosis, initially presenting as irregularly shaped solid lung nodules with heterogeneous enhancement, such cases are rarely reported. Patient concerns: A 69-year-old male was initially misdiagnosed with lung cancer based on the identification of solid lung nodules during routine physical examination. Pathological findings from a lung biopsy were inconclusive. Due to the atypical chest computed tomography presentation, the diagnosis was delayed by nearly 2 months and involved 3 different hospitals. Diagnosis: The definitive clinical diagnosis was GPA complicated by a pulmonary embolism. Interventions: Methylprednisolone was administered, and immunosuppressive therapy was initiated following infection control. Outcomes: At outpatient follow-up, most of the patient’s clinical indicators has returned to normal. Lessons: Pulmonary involvement occurs in over 90% of GPA cases, with characteristic thoracic radiologic findings including solitary or multiple nodules, masses, cavities, and consolidation, with a propensity for lesion recurrence. Clinicians should consider GPA in antibiotic-refractory “pneumonia” with unexplained extrapulmonary manifestations.