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2009 Southern Regional Meeting Abstracts
Session: Pediatric Clinical Symposium
AN UNUSUAL PRESENTATION OF WEGENER'S GRANULOMATOSIS IN A CHILD
Toups L1, Wells W1, Swartz B2. 1LSUHSC Children's Hospital, Shreveport, LA and 2LSUHSC, Shreveport, LA.
Case Report: 11 year old African American female presented to outside hospital with chief complaint of chest pain and shortness of breath for 1 month prior to presentation. She was initially treated for asthma with no improvement. She presented again with increased symptoms and was transferred to our instituition. Pertinent positives in review of systems included cough, abdominal pain, malaise, poor appetite, nausea, vomiting, recent contact with someone on antituberculosis medications, and a 27 pound weight loss in 2 months. Pertinent negatives included no hemoptysis or in-home smokers. Chest xray showed large mass in right perihilar area. Subsequently, CT of lung revealed large mass below the carina partially obstructing the right mainstem bronchus and a cavitary mass in the right lower lobe suspicious for neoplasm. Inconclusive laboratory data showed elevated ESR, negative ANCA studies, PPD, and histoplasmosis titers. Resection of the lesion was performed. Patholgy revealed vasculitis and granulomatous inflammation with necrosis consistent with Wegener's Granulomatosis. Patient is being treated with the combination of methotrexate and corticosteroids and maintains close follow up with primary care physician and rheumatology.
DDx:
| Tuberculosis | Rheumatologic diseases: SLE Sarcoidosis Wegener's Granulomatosis Juvenile Rheumatoid Arthritis Myositis | | Cancer | | Pneumonia | | Histoplasmosis | | Foreign Body | |
CT chest showing cavitary lesion in right lower lobe
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