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.