Pleuroparenchymal fibroelastosis with positive MPO-ANCA diagnosed with a CT-guided percutaneous needle biopsy

BMJ Case Reports
Hideaki YamakawaTakashi Ogura

Abstract

A 67-year-old woman was referred to our hospital because of gradually increasing dyspnoea on exertion for 6 months. Chest CT scan showed subpleural parenchymal fibrotic opacities with traction bronchiectasis in the bilateral upper lung fields. Serum rheumatoid factor and myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) were positive. There was no evident reason to suspect connective tissue disease such as ANCA-associated vasculitis or rheumatoid arthritis. We performed a CT-guided percutaneous needle biopsy of the subpleural lesion that showed slight uptake on the fluorodeoxyglucose-positron emission tomography (FDG-PET) CT scan. This specimen showed subpleural fibrosis as evidenced by an abnormal increase of elastic tissue and minimal collagen deposition, which indicated pleuroparenchymal fibroelastosis (PPFE). Although PPFE can be associated with a variety of causes, its association with MPO-ANCA is unknown. A CT-guided transthoracic lung biopsy caused no adverse events and was useful in the diagnosis of PPFE in our patient.

References

Jun 9, 2004·Respirology : Official Journal of the Asian Pacific Society of Respirology·Sakae HommaKoichiro Nakata
Sep 21, 2012·Respiratory Medicine·Tomonori TanakaJunya Fukuoka
Sep 17, 2013·American Journal of Respiratory and Critical Care Medicine·William D TravisUNKNOWN ATS/ERS Committee on Idiopathic Interstitial Pneumonias
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Aug 19, 2016·Respiratory Medicine Case Reports·Hisako KushimaKentaro Watanabe

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Citations

Oct 18, 2018·Virchows Archiv : an International Journal of Pathology·Yoshiaki KinoshitaKazuki Nabeshima

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