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Hepatic involvement in granulomatosis with polyangiitis – diagnostic difficulties

We report the case of a 57-year-old Caucasian man who presented with dry cough, haemoptysis, fever, lung nodules, erythrocyturia, and acute hepatitis. After a lung biopsy, the patient was diagnosed with granulomatosis with polyangiitis. The diagnosis was supported by the presence of anti-proteinase-...

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Autores principales: Masiak, Anna, Drobińska, Anna, Zdrojewski, Zbigniew
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji w Warszawie 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5825971/
https://www.ncbi.nlm.nih.gov/pubmed/29491541
http://dx.doi.org/10.5114/reum.2017.72630
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author Masiak, Anna
Drobińska, Anna
Zdrojewski, Zbigniew
author_facet Masiak, Anna
Drobińska, Anna
Zdrojewski, Zbigniew
author_sort Masiak, Anna
collection PubMed
description We report the case of a 57-year-old Caucasian man who presented with dry cough, haemoptysis, fever, lung nodules, erythrocyturia, and acute hepatitis. After a lung biopsy, the patient was diagnosed with granulomatosis with polyangiitis. The diagnosis was supported by the presence of anti-proteinase-3 anti-neutrophil cytoplasmic antibodies. The most common causes of liver damage are excluded. The patient was treated with prednisone and cyclophosphamide, which resulted in remission of chest CT findings and improvement in liver function tests. During the flare, new lung infiltrations as well as elevation of liver enzymes were present. Treatment with rituximab resulted in complete clinical and radiological remission and normalisation of liver function tests. What makes this case worth reporting is the rare liver involvement in the GPA. After exclusion of coexistence of autoimmune liver disease and drug-induced liver lesion, organ involvement was supported by the reversion of abnormal LFT after the immunosuppression of GPA.
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spelling pubmed-58259712018-02-28 Hepatic involvement in granulomatosis with polyangiitis – diagnostic difficulties Masiak, Anna Drobińska, Anna Zdrojewski, Zbigniew Reumatologia Case Report We report the case of a 57-year-old Caucasian man who presented with dry cough, haemoptysis, fever, lung nodules, erythrocyturia, and acute hepatitis. After a lung biopsy, the patient was diagnosed with granulomatosis with polyangiitis. The diagnosis was supported by the presence of anti-proteinase-3 anti-neutrophil cytoplasmic antibodies. The most common causes of liver damage are excluded. The patient was treated with prednisone and cyclophosphamide, which resulted in remission of chest CT findings and improvement in liver function tests. During the flare, new lung infiltrations as well as elevation of liver enzymes were present. Treatment with rituximab resulted in complete clinical and radiological remission and normalisation of liver function tests. What makes this case worth reporting is the rare liver involvement in the GPA. After exclusion of coexistence of autoimmune liver disease and drug-induced liver lesion, organ involvement was supported by the reversion of abnormal LFT after the immunosuppression of GPA. Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji w Warszawie 2017-12-30 2017 /pmc/articles/PMC5825971/ /pubmed/29491541 http://dx.doi.org/10.5114/reum.2017.72630 Text en Copyright: © 2017 Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji w Warszawie http://creativecommons.org/licenses/by-nc-sa/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
spellingShingle Case Report
Masiak, Anna
Drobińska, Anna
Zdrojewski, Zbigniew
Hepatic involvement in granulomatosis with polyangiitis – diagnostic difficulties
title Hepatic involvement in granulomatosis with polyangiitis – diagnostic difficulties
title_full Hepatic involvement in granulomatosis with polyangiitis – diagnostic difficulties
title_fullStr Hepatic involvement in granulomatosis with polyangiitis – diagnostic difficulties
title_full_unstemmed Hepatic involvement in granulomatosis with polyangiitis – diagnostic difficulties
title_short Hepatic involvement in granulomatosis with polyangiitis – diagnostic difficulties
title_sort hepatic involvement in granulomatosis with polyangiitis – diagnostic difficulties
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5825971/
https://www.ncbi.nlm.nih.gov/pubmed/29491541
http://dx.doi.org/10.5114/reum.2017.72630
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