A 54 yr old smoker man comes with fever, hemoptysis, weight loss and oligo arthritis. Serial skiagram shows fleeting opacities. What is the diagnosis –
Correct Answer: Wegeners granulomatosis
Description: Ans. is 'd' i.e., Wegner's granulomatosis On first instance, presence of fleeting opacities and hemoptysis makes it look like a case of allergic bronchopulmonary aspergillosis.But presence of oligoarthritis and weight loss cannot be explained by allergic bronchopulmonary aspergillosis. Presence of fever, hemoptysis and weight loss suggests T.B. or carcinoma.But these two diseases cannot explain fleeting opacities and oligoarthritisThe chest X-ray appearance in carcinoma lung is usually a peripheral or central pulmonary mass depending upon the type of Ca. (Fleeting opacities are not associated with lung Ca).Fleeting opacities are not associated with T.B. tooBesides allergic bronchopulmonary aspergillosis, the other option that may show presence of fleeting opacities in chest X-ray is "Weener's granulomatosis".Chest X-ray of Wegner granulomatosis."Lesions occur in any part of the respiratory tract and take the form of inflammatory necrosis in the walls of small arteries and granulomatous masses upto several centimetres in diameter are apparent on chest-x- ray. These are fairly well defined and they often cavitate; the lesion may resolve spontaneously while new masses appear. There is considerable day to day variability and eventual total resolution of these abnormalities occur after t/t with prednisolone and cyclophosphomilase"About oligoarthritis and weight lossBoth the above mentioned features are seen in Wegner's granulomatosis.Wegener's granulomatosis presents with nonspecific constitutional symptoms such as fatigue, myalgia, weight loss and fever.Joint involvement in Wegner's granulomatosis take the form of pauci or polyarticular arthritis.
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