Pulmonary metastasis in a patient with simultaneous bladder cancer and relapsing granulomatosis with polyangiitis

Mauricio Danckers, Fang Zhou Fang, Diana Nimeh, H. Michael Belmont, David J. Steiger

Research output: Contribution to journalArticlepeer-review


Objective: Unusual clinical course Background: Granulomatosis with polyangiitis (GPA) relapse can complicate the differential diagnosis of pulmonary lesions. Case Report: A 70-year-old male smoker with GPA and emphysema presented with dyspnea, dry cough, and a right upper lobe pulmonary ground-glass opacity that persisted despite antibiotics. A trans-bronchial biopsy did not reveal active vasculitis, malignancy, or infection. He was treated for presumed GPA relapse based on pulmonary manifestations, renal failure, and elevated PR3-ANCA. Later, hematuria led to the cystoscopic discovery of a bladder wall lesion, which was diagnosed as micropapillary urothelial carcinoma not involving the muscularis propria. The patient developed an increasing pulmonary infiltrate with a new solid component, satellite lesions, and regional lymphadenopathy. A right upper lobe wedge resection showed metastatic urothelial carcinoma. Conclusions: The simultaneous presentation of a pulmonary lesion and GPA relapse is a diagnostic challenge. The differential diagnosis should include the rare possibility of metastatic urothelial carcinoma, regardless of how the lesion appears radiographically.

Original languageEnglish
Pages (from-to)287-291
Number of pages5
JournalAmerican Journal of Case Reports
StatePublished - 14 May 2015
Externally publishedYes


  • Anti-neutrophil cytoplasmic antibody-associated vasculitis
  • Antibodies
  • Antineutrophil cytoplasmic
  • Hematuria
  • Solitary pulmonary nodule
  • Wegener granulomatosis


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