Correct!
4. 1 and 3
Correct!
4. 1 and 3
In general, hemoptysis is an indication for bronchoscopy usually for evaluation of an endobronchial tumor. The patient has signs and symptoms of disease in the upper airway, genitourinary symptoms and neurological system. Disorders of the blood vessels is one way of connecting these diffuse abnormalities. A positive serum ANCA is often seen with some vasculitides. Although prostate cancer can occasionally metastasize to the lung it would seem unlikely to explain the diffuse symptoms. Furthermore, a digital rectal exam and prostate specific antigen (PSA) were normal.
Bronchoscopy was performed and showed diffusely erythematous and edematous bronchi (Figure 3A and 3B) with some blood in the airways (Figure 3C).
Figure 3. Representative photographs taken at bronchoscopy.
A serum c-ANCA was positive at 1:1024.
Bronchial biopsies were interpreted as showing necrotizing vasculitis with granulomatous inflammation accompanied by an inflammatory infiltrate composed of a mixture of neutrophils, lymphocytes, plasma cells, histiocytes, and eosinophils (Figure 4).
Figure 4. Panel A: Low power view showing endobronchial biopsies. Panels B & C: higher power views showing vasculitis with granulomata.
What is the likely diagnosis? (Click on the correct answer to proceed to the fourth of five panels)