Introduction:
In an era where all the diagnostic tools are readily available ;relatively straight forward diagnosis is getting missed. Like the saying goes always see for common things first. Pulmonary renal syndrome is a common finding in anti-neutrophil cytoplasmic antibody positive vasculitis but in this case report it’s presence got camouflaged by elevated cancer antigen -19-9 and positron emission tomography report.
Methods:
A chronic kidney disease patient on haemodialysis had history of haemoptysis ,pallor and raised creatinine. He was taking voriconazole for allergic bronchopulmonary aspergillosis. He undergone positron emissions tomography ;which suggested multiple subpleural and parenchymal nodules in bilateral lungs; which was suggestive of infective etiology(? disseminated aspergillosis or tuberculosis).Also diffuse flurodeoxyglucose uptake in bulky pancreas with peripancreatic fat stranding.
Results:
Computed tomography guided biopsy of lung nodules was done which was suggestive of granulomatous lesions. Endoscopy guided pancreatic biopsy was done ; which was negative for malignancy. As patient continued to have haemoptysis ; a renal biopsy was done along with antineutrophil cytoplasmic antibody work-up. C-antineutrophil cytoplasmic antibody turned out to be positive and renal biopsy was suggestive of cresenteric glomerulonephritis. Patient was given rituximab and he received 7 sessions of plasmapheresis.Patient's haemoptysis subsided and urine output improved as well.
Conclusions:
Clinical diagnosis are augmented by investigations and not the other way around.Pulmonary renal syndrome is a common occurrence in antineutrophil cytoplasmic antibody positive vasculitis but in the camouflage of elevated cancer antigen -19-9 and positron emission tomography report it's presence got obscured.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.