Bacterial Pneumonia Concealing Pulmonary Granulomatosis with Polyangiitis: A Diagnostic Difficulty

Granulomatosis with polyangiitis (GPA) is a necrotizing vasculitis which primarily involves upper respiratory tract, lungs and kidneys. Lung involvement is bilateral parenchymal nodules which may cavitate. We present a case of a 60-year-old male with cough, hemoptysis, and fever. Clinical and radiological examination revealed bilateral multilobar cavitating consolidation. Diagnostic bronchoscopy was performed, and bronchial wash grew Klebsiella pneumoniae. Despite sensitive antibiotics, the patient worsened. On further investigations, granulomatosis with polyangiitis (GPA) was proved by serology and histopathological examination of lung biopsy. The patient succumbed to respiratory failure before specific treatment initiation. As there was overlapping Klebsiella infection, underlying pulmonary vasculitis was overlooked. Hence in all cases with hemoptysis and a cavitating consolidation, pulmonary vasculitis should be worked up in order to avoid poor outcomes.