Asemptomatik Akciğere Sınırlı Granülomatöz Polianjitis Olgusu

Elli yaşında kadın hasta vajinal kanama nedeniyle Kadın Hastalıkları ve Doğum servisine başvurmuş. Hastaya miyoma uteri tanısı konarak operasyon kararı verilmiş. Hastanın preoperatif değerlendirme sırasında akciğer grafisinde bilateral şüpheli nodül saptanması üzerine çekilen Toraks Bilgisayarlı Tomografisin’ de sağ alt lob süperior segment ve sol alt lob posterobazal segmentte nodüler lezyonlar saptandı. Sağ akciğer tru-cut biyopside ‘interstisyel ve perivasküler alanlarda granülom formasyonu, nötrofil ve lenfosit infiltrasyonu, fibrinoid nekroz’ izlendi. Otoantikor tetkiklerinde c-ANCA pozitifliği saptandı. Hastanın Göz, K.B.B. ve nefrolojik muayenesinde patoloji saptanmadı. Mevcut bulgularla hastaya 'Akciğere Sınırlı Granülomatöz Polianjitis' tanısı kondu. Düşük doz haftalık oral metotreksat, prednizon ve folik asit tedavisi başlandı. Hasta komplikasyonsuz total abdominal histerektomi ve bilateral salpingo ooferektomi operasyonu oldu. Hastanın asemptomatik olması ve hastalığın nadir görülmesi nedeniyle, literatür tartışması eşliğinde sunuldu.

A Case of Asymptomatic Pulmonary Limited Granulomatosis with Polyangiitis

A 50-year-old female patient was admitted to the Obstetrics and Gynecology Department with vaginal bleeding. The patient was diagnosed with uterine myoma, and an operation was scheduled. A chest radiography revealed suspicious bilateral nodules during the preoperative evaluation of the patient. A thoracic computed tomography revealed bilateral nodular lesions in the superior segment of the right lower lobe and the posterobasal segment of the left lower lobe. A core needle biopsy of the right lung revealed a granuloma formation, neutrophil and lymphocyte infiltration, and fibrinoid necrosis in the interstitial and perivascular area. c-ANCA positivity was detected in autoantibody tests. Eyes, ears, nose, mouth and nephrological examinations of the patient revealed no pathology. The patient was diagnosed with Pulmonary Limited Granulomatosis with Polyangiitis, based on the present findings. Treatment with low dose weekly oral methotrexate, prednisone and folic acid was planned. The patient underwent a total abdominal hysterectomy and a bilateral salpingo oophorectomy without complications. The case is presented with a literature review given the asymptomatic status of the patient and the rarity of the disease.

Kaynakça

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