Cannonball opacities in a pregnant woman.

Abstract

A 26-year-old woman presented at week 20 of pregnancy with a 3-month history of fever, cough, and breathlessness. She had hearing loss, epistaxis, nasal crusting, haemoptysis, and a purpuric rash over her legs. No significant weight loss was reported. Chest x-ray (with abdominal shield) showed bilateral cannonball opacities, and contrast-enhanced chest CT (with abdominal shield) revealed multiple nodules, without pleural effusion or lymphadenopathy (figure). Ultrasound of the patient's abdomen and pelvis showed a single live fetus and no abnormalities. Her haemoglobin concentration was 8·3 g/dL, total leucocyte count was 8·6 × 109/L, platelet count was 600 × 109/L, erythrocyte sedimentation rate was 65 mm/h, and C-reactive protein concentration was 186 mg/L. The patient's serum anti-proteinase 3 antibody concentration was 102 U/mL. Sputum acid-fast bacilli and fungal smear, serum β-D-glucan and galactomannan, and Mantoux test results were all negative. A diagnosis of granulomatosis with polyangiitis was made.