PMC9664009_01
(A-1, A-2, and A-3) Chest CT images at the first visit show pulmonary multipe nodular shadows, bronchiectatic changes, infiltrates, and centrilobular branching opacities. (B-1, B-2, and B-3) Six months after the first visit, chest CT at the emergency center visit shows multiple cavitary and noncavitary lung masses with peripheral and upper-lobe predominance in both lungs.. CT, computed tomography.
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Computed tomography (CT) reveled bilateral otitis media, sinusitis, multiple nodular shadows in the lungs, bronchiectatic changes, infiltrates, and centrilobular branching opacities (Fig. 1A). Chest CT showed multiple cavitary and noncavitary masses with peripheral and upper-lobe predominance in both lungs (Fig. 1B).
The lung biopsy specimen shows micro abscesses ( ), necrotizing vasculitis ( ), rupture of the internal elastic plate ( ), and granuloma ( ). Scale bar = 100 mum. (A, C: Hematoxylin and eosin staining, B: Elastica van Gieson staining).
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Furthermore, histological examination of transbronchial biopsy specimens obtained from masses revealed micro abscesses and necrotizing granulomatous vasculitis, which were consistent with GPA (Fig. 2).
Clinical course.
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However, with regard to the auditory capacity, moderate hearing loss persisted without further improvement in hearing ability at the end of the remission-induction therapy (Fig. 3).