Dr. Sunita Sabarwal

Dr.PRIYANKA, Dr.KHUSHBOO CHAUHAN, Dr.DEEPAK SONI

Abstract

A 60‑year‑old female misdiagnosed initially as a case of panophthalmitis on the basis of examination findings; congested scleral-vessels, pseudophakia with perilenticular fluffy exudates, grade 4+ inflammation in anterior chamber, exudates in vitreous and subretinal space with retinal detachment at presentation. Work-up revealed neutrophilia, raised ESR and a lung mass/nodule in left lung. Intensive antifungal regime was started with oral NSAID suspecting pulmonary aspergilloma‑related endogenous infection. Later high c‑ANCA and multiple cavitary lesions in both lungs led us to revise diagnosis to granulomatosis polyangiitis (GPA). Patient was successfully managed with intravenous steroids and cyclophosphamide with supportive topical therapy. Initial work-up and severity at presentation suggestive of fungal infection leads to initial misdiagnosis but predisposing factors were absent. GPA carries high mortality rate and demands a high degree of clinical suspicion for timely management.