Abstract Introduction GPA is a type of necrotizing vasculitis that primarily affects small-sized arteries. The upper and lower respiratory tracts and the kidneys are the most affected organs. There is limited evidence in current literature that GPA can be diagnosed via transbronchial lung cryobiopsy (TBLC); typically, diagnosis relies on surgical lung biopsy. We are reporting a case of multilobar pulmonary infiltrates due to a GPA diagnosis of TBLC to illustrate a potential diagnostic shift. Case Description A female in her 50s presented with acute right-sided chest pain and dyspnea, requiring 4 L/min of oxygen. Chest CT showed progression of multifocal mass-like consolidations, worsening mediastinal adenopathy, a pericardial effusion, and a small left pleural effusion. Laboratory work showed positive cytoplasmic antineutrophilic cytoplasmic antibody (C-ANCA) with elevated proteinase 3 antibody (PR3) and high ESR and CRP. Echocardiogram demonstrated pericardial effusion. Colchicine and high-dose NSAIDs were initiated. Bronchoscopy revealed abnormal cobblestone mucosa in multiple lung lobes, along with mediastinal and hilar lymphadenopathy. TBLC showed necrotizing granulomatous inflammation and giant cells. The constellation of PR3-ANCA positivity, bilateral mass-like pulmonary consolidations, pericardial effusion, and pathology on TBLC were consistent with GPA. She was treated with pulse-dose corticosteroids, rituximab, and subsequent clinical improvement. Discussion GPA is often confirmed by surgical lung biopsy or extrapulmonary tissue. In our case, TBLC provided a minimally invasive, high-yield alternative diagnostic tool that directly guided therapy. TBLC has been evolving as a reliable diagnostic tool in patients with pulmonary infiltrates of unclear etiology. TBLC in the diffuse lung parenchymal diseases/ILD has shown a high tissue diagnostic yield with an acceptable safety profile in the tertiary care centers. This data has also been recently replicated in the US community hospital setting with similar outcomes and safety profile. Use of TBLC as a diagnostic tool for conditions like ANCA- associated vasculitis is less studied. Inpatient TBLC may also accelerate diagnosis and treatment, a practical advantage when disease is rapidly evolving, as in this patient with progressing consolidations and worsening symptomology, as those patients are clearly at high risk for surgical lung biopsies. Case reports in the literature further reinforce the successful role of TBLC in establishing GPA diagnosis in patients with nondiagnostic nasal biopsies and in those presenting with atypical pulmonary findings. TBLC could be a safe diagnostic approach in ANCA-associated vasculitis. TBLC should be considered a valuable diagnostic tool for suspected diagnoses of conditions like GPA, which can reduce morbidity compared with surgical biopsy. This abstract is funded by: None
Mushtaq et al. (2026) studied this question.