PMC9556222_01
CT findings before and after surgery: (A-C) CT findings on October, 2019 (before surgery): There were two pulmonary nodular shadows (S1 and S6) and stenosis of the left ear canal. (D-F) CT findings on January, 2020 (after surgery): The lung nodule (S1) was resected surgically (red arrow). After that, another nodule (S6) disappeared two weeks later, and the stenosis of left ear canal improved without treatment (blue arrow and round). (G-H) CT findings on November, 2020: There was no relapse, even at one year after the surgery.
1349-7235-61-2803-g001.jpg
PMC9556222_01_1349-7235-61-2803-g001.jpg
g001
CT revealed stenosis of the left ear canal and two pulmonary nodular shadows (Fig. 1A-C). The stenosis of the left ear canal also improved (Fig. 1D-F).
Histopathological findings of the resected lung tissue (S1): (Left) Severe inflammatory infiltration including neutrophils is seen in the alveolar walls [Hematoxylin and Eosin (H&E) staining, x20]. (Middle) An epithelioid cell granuloma with multinucleated giant cells (black arrows) is detected (H&E staining, x200). (Right) The small pulmonary artery is experiencing neutrophil infiltration (black arrows) (H&E staining, x400).
1349-7235-61-2803-g002.jpg
PMC9556222_01_1349-7235-61-2803-g002.jpg
g002
A histopathological examination of the resected lung tissue (S1) obtained on thoracoscopic partial lung resection showed characteristic features of GPA, including inflammatory cell infiltration into the vascular wall and granulomatous lesions with multinucleated giant cells, without any findings of malignancy, infection, or germinal center formation (Fig. 2).
Clinical course: After partial lung resection, her symptoms of a fever, cough, and ear fullness improved, and the levels of CRP and myeloperoxidase (MPO)-ANCA decreased gradually.
1349-7235-61-2803-g003.jpg
PMC9556222_01_1349-7235-61-2803-g003.jpg
g003
Ultimately, the symptoms disappeared completely, and a laboratory examination showed decreased CRP and MPO-ANCA levels (Fig. 3). The symptoms showed no flare up within one year after surgery, and the MPO-ANCA level continued to decrease (Fig. 3).