Introduction
Granulomatosis with Polyangiitis (GPA) is a small-medium vessel necrotizing vasculitis and is a component of Anti-Neutrophil Cytoplasmic Antibody (ANCA) Associated Vasculitides1. It has a peak incidence at 64 to 75 years of age and is commonly reported in Caucasians without sex predilection2. Although almost any organ can be involved in GPA, the upper respiratory tract, lower respiratory tract, and kidneys are commonly affected3. The severity of the disease can be heterogeneous. We report a unique case of granulomatosis with polyangiitis (GPA) in a 26-year-old Asian female who was initially transferred from an outside hospital due to shortness of breath presumed to be caused by COVID-19 pneumonia. However, further evaluation led to the diagnosis of GPA highlighting the importance of considering GPA in the differential diagnosis, even in younger individuals and those presenting with respiratory symptoms suggestive of COVID-19.