Journal of Vasculitis

The Bugs were not to Blame; Granulomatosis with Polyangiitis Presenting as a Renal Mass

Abstract

Kwabena Sefah Nketiah Sarpong*, Marat Kribis, Vesna Buntak and Christine Minerowicz

Granulomatosis with Polyangiitis (GPA) is an anti-neutrophil cytoplasm antibody (ANCA) associated vasculitis that rarely presents as a solitary renal mass. We present a 57-year-old male who presented with abdominal pain and was found to have a complex right renal lesion on abdominal imaging. He later developed fevers, hypoxic respiratory failure and acute kidney injury. Chest imaging showed confluent consolidative changes in the mid to lower lung zones. He was started on antibiotics but continued to worsen. He was noted to have diffuse alveolar hemorrhage on bronchoscopy with autoantibodies to proteinase-3 (PR-3) returning positive. He was started on rituximab and steroids with dramatic improvement. Kidney biopsy revealed crescentic and necrotizing glomerulonephritis associated with ANCA-associated vasculitis. GPA presenting as a renal mass presents a diagnostic challenge. Prompt diagnosis is however paramount given how fast GPA can progress.