Wegener's Granulomatosis: A report of two Cases with different clinical and laboratory features

We present two cases of Wegener’s granulomatosis (WG) with systemic involvement. Our first case, a 50 year old female, presented with painful vesicles on the left side of neck and chest. She was diagnosed as post-primary tuberculosis due to persistent cough and a nodular opacity in the left lower lobe of the lung. A wedge biopsy of the lung tissue did not show any mycobacteria, and an open biopsy showed granulomatous inflammation with necrosis. The serology for cytoplasmicantineutrophil cytoplasmic antibodies (c-ANCA) and perinuclear – antineutrophil cytoplasmic antibodies (p-ANCA) was negative and renal parameters were normal. Our second case, a 50 year old male, presented with fever, cough with expectoration, and blood stained nasal discharge for the past 15 days with no cutaneous lesions. The renal biopsy showed cresentic glomerulonephritis and serum tested positive for c – ANCA. Both the cases were diagnosed as WG and managed using corticosteroids and/or cytotoxic medications. These cases represent the different clinical and laboratory features of limited and classical forms of WG respectively, and though the second case did not require extensive investigations, the first case posed a diagnostic challenge since one of the common differential diagnosis of nodular lung involvement with persistent cough in developing countries is tuberculosis.