Open AccessGranulomatosis with polyangitis with mononeuritis multiplex-immunosuppressives playing a double-edged sword
Author(s) -
Subhasis Mukherjee,
Debabrata Biswas,
Shabana Begum,
Pulakesh Bhanja,
Amartya Kumar Misra,
Partha Chatterjee
Publication year - 2014
Publication title -
lung india
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 25
eISSN - 0974-598X
pISSN - 0970-2113
DOI - 10.4103/0970-2113.142143
Subject(s) - medicine , prednisolone , mononeuritis multiplex , bronchoalveolar lavage , dermatology , pulmonary hemorrhage , voriconazole , disseminated intravascular coagulation , surgery , vasculitis , lung , antifungal , disease
A 52-year-old female was diagnosed with rheumatoid arthritis and was on methotrexate and prednisolone. She developed fever, cough, hemoptysis, and cavitary lesion on chest skiagram. She was put on antitubercular therapy without any improvement, meanwhile she developed painful right foot drop. Clinicoradiology and C-ANCA study confirmed the diagnosis of granulomatosis with polyangitis (GPA). She was started on cyclophosphamide, corticosteroid, and co-trimoxazole. While her treatment was being continued she showed significant improvement of pulmonary manifestations. About 1 year later, there was reappearance of fever, cough, and radiological opacity with oropharyngeal candidiasis. She became very ill with disseminated intravascular coagulation (DIC)-like features. Immunological markers were negative but bronchoalveolar lavage fluid study showed growth of Aspergillus spp. The patient was promptly put on intravenous voriconazole but unfortunately she succumbed to her illness.