Contributed by Hae-Sun La, MD and Tanner Bartholow, MD
CLINICAL HISTORY
A woman in her 30's presented with few weeks of productive cough, fatigue, sore throat, and unintentional weight loss. She had been treated for sinus infection and suspected bronchitis with multiple courses of antibiotics. On imaging, she was found to have multiple cavitary lesions in the lung. It was also noted that she had a new bump on her nose. She was admitted and treated with antibiotics for sepsis secondary to suspected pulmonary infection. Over the course of her admission, she developed hypoxic respiratory failure and had multiple episodes of hypotension. Her condition continued to worsen and was pronounced deceased. A hospital autopsy was performed.
GROSS EXAMINATION
There was a saddle nose deformity.
Both lungs were heavy, adherent to the pericardium, and with irregular cavitary lesions. The airways were partially obstructed with surrounding necrotic-appearing parenchyma.
MICROSCOPIC DESCRIPTION
Lungs: Nodular lesions and geographic necrosis
Inflammatory infiltrate consisting of a mixture of neutrophils, eosinophils, plasma cells, and lymphocytes
Vasculitis