Table 1: Laboratory findings of the patient
Evaluation for vasculitis because of hematuria, cavitary lung lesions,
and neurologic presentation of the disease by testing for ANA, Anti ds
DNA, RF, Anti CCP Ab, P-ANCA, and C-ANCA was performed. All the tests
were negative, and the level of serum complements was normal. Thoracic
surgery consults for the dominant cavity in left lung management
recommended radiologic intervention by inserting a pneumothorax
catheter. Unfortunately, this intervention failed due to technical
difficulties. The patient’s general condition improved gradually.
Cardiac MRI was carried out in another center, and there was no evidence
of RA mass or any other significant cardiac abnormalities. Hematuria
resolved independently, and we assumed that it was due to trauma during
urinary catheterization. As the antifungal treatment continued, the
patient’s condition improved. We referred the patient for cavity
sampling under the CT guide. The sample’s PCR test result was positive
for aspergillosis. Treatment with intravenous Voriconazole continued for
three weeks in the hospital, and a follow-up chest CT scan revealed
significant improvement (figure 3). A neurologic consult recommended
extending the antiplatelet therapy for three months after discharge and
performing cardiac Holter monitoring and checking coagulation profile,
including fibrinogen level, protein C, protein S, and Antithrombin III
level. All of these tests were normal. The Holter monitor device did not
reveal any abnormality. The patient was followed for three months in the
clinic while continuing oral Voriconazole. After three months, lung
cavitary lung lesions disappeared completely, and the patient got
symptoms free. The patient’s neurologic symptoms also improved, and
antiplatelet therapy was terminated after consultation with a
neurologist.