16 year old male patient came with the chief complaints of fever and multiple joint pain since 12 days and epistaxis since 2 days prior to admission. Patient was apparently alright 3 months back when he developed fever with cough for which the patient was evaluated and was found to have cervical lymphadenopathy. Chest X ray and High Resolution Computed Tomography of thorax was suggestive of Cavitation in the lower lobe of right lung. Patient was then referred to higher center as a case of pulmonary tuberculosis. Patient was evaluated and was found to have nasal crustings,hair loss,renal involvement in the form of Proteinuria. Anti Nuclear Antibody was strongly positive with ANA blot suggestive of positivity for anti-Double stranded Deoxyribonucleic acid and Anti Histones. Patient was also found to be p-Antineutrophil cytoplasmic antibodies positive. Repeat HRCT thorax was suggestive of Cavitations in the lower lobe of right lung along with consolidation in bilateral lungs. Sputum for Acid fast bacillus and cartridge- based nucleic acid amplification test were negative. Sputum gram staining was suggestive of gram negative bacilli along with gram positive budding yeast cells. On the basis of the history, examination and investigations the diagnosis of Systemic Lupus Erythematosus with Granulomatosis with Polyangiitis was kept. Patient was given Pulse therapy of injection methyl prednisolone followed by oral prednisolone along with oral cyclophosphamide. Patient improved symptomatically and was discharged.
Keywords: Systemic lupus erythematosus, Granulomatosis with polyangiitis, Methyl prednisolone, Cyclophosphamide