Figure 2: Computed Tomography (CT) chest showing dense consolidation of the entire right lung and peripheral infiltrates in the left lung.
To confirm the diagnosis, a Video-assisted thoracoscopic surgery (VATS)-guided lung biopsy was performed, showing characteristic histological features of ANCA-associated vasculitis, including fibrin and blood filling the alveolar space, inflammatory infiltrate with neutrophils, scattered areas of necrosis, endothelial damage, and necrotizing vasculitis as shown in Figure 3 and Figure 4. Despite the absence of well-formed granulomata, the findings supported the diagnosis of GPA. Treatment with methylprednisolone and rituximab led to medical stabilization, although the patient experienced complications of subcutaneous emphysema and progressive lower extremity neuropathic symptoms.
Following successful stabilization, the patient was discharged home with a walker due to foot drop and was scheduled for outpatient neurology and rheumatology follow-up.