Granulomatosis with polyangiitis (GPA) is a multi system auto-immune disease that involves small to medium sized vessels and is associated with high mortality and morbidity. GPA exhibits a continuous and difficult clinical diagnostic concern due to peculiarity of the disease and heterogeneity of the manifestations. A 55 years old female was admitted to GSL General Hospital, Rajamahendravanam with chief complaints of loss of weight, persistent cough, SOB with grade III m-MRC score, low grade fever and evening raise of temperature. Chest radiograph and C.T scan showed randomly spread multiple sub-pleural and intra parenchymal nodules. C.T guided FNAC revealed mesothelial hyperplasia with no malignant cells. ESR was 45 mm in 1st hour. Ultra sonography of abdomen was performed and revealed mild hepatomegaly, C.T guided FNAB was done from the left upper lobe pulmonary nodule, report showed granulomas with focal angiitis favours granulomatosis polyangiitis. After treatment with prednisolone and cyclophosphamide the chest radiograph and C.T chest showed marked improvement in the lesions. Early diagnosis and disciplinary approach to management are required to decrease recurrence and morbidity in patients with GPA.
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