Journal of Pulmonary Medicine & Respiratory Research Category: Medical Type: Case Report
Increased FDG-PET Uptake in Granulomatosis with Polyangiitis: Case Report and Review of the Literature
- Rama El-Yafawi1*, Thomas E Van Der Kloot1, Patricia Cantlin2
- 1 Departments Of Pulmonary And Critical Care Medicine, Maine Medical Center, Portland, United States
- 2 Departments Of Nephrology, Maine Medical Center, Portland, United States
*Corresponding Author:Rama El-Yafawi
Departments Of Pulmonary And Critical Care Medicine, Maine Medical Center, Portland, United States
Received Date: May 09, 2018 Accepted Date: Jun 08, 2018 Published Date: Jun 22, 2018
c-ANCA: Cytoplasmic-Antineutrophil Cytoplasmic Autoantibody
CT: Computed Tomography
GPA: Granulomatosis with Polyangiitis
PET: Positive Emission Tomography
RLL: Right Lower Lobe
Pulmonary nodules and masses are common radiologic findings and increased FDG activity has been reported in patients with GPA; median SUVmax has generally been reported within a range of 7.6-9, as compared to our patient, who had an SUVmax of 13.1 [14,15].
Despite its limitation in differentiating inflammatory diseases from malignancies, FDG-PET/CT may have a role in early diagnosis of GPA. In certain patients, it can provide valuable guidance for optimal biopsy site, localization of organ involvement and characterization of disease severity, which could have treatment implications [14-17]. Furthermore, a case series reported a remarkable decrease in FDG uptake with treatment . This indicates that FDG uptake correlates with disease activity in GPA.
This case demonstrates an unusual radiographic presentation of GPA, with findings initially concerning primarily for malignancy, particularly related to the observed increased FDG uptake in mediastinal and hilar lymph nodes. This resulted in a delay in the diagnosis of GPA, which became evident only with development of acute kidney injury with rapidly progressive glomerulonephritis. Despite this delay, clinical response was achieved with corticosteroids, rituximab, cyclophosphamide, plasmapheresis and hemodialysis, with recovery of renal function, resolution of CT imaging and normalization of c-ANCA titers.
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Citation: El-Yafawi R, Van der Kloot TE, Cantlin P (2018) Increased FDG-PET Uptake in Granulomatosis with Polyangiitis: Case Report and Review of the Literature. J Pulm Med Respir Res 4: 016.
Copyright: © 2018 Rama El-Yafawi, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.