Case Report Diagnostic Dilemma of Antineutrophil Cytoplasmic Antibody Seropositivity in Human Immunodeficiency Virus Infection Prasanta R. Mohapatra, Sushant Khanduri, Naveen Dutt, Preeti Sharma and Ashok K. Janmeja Department of Pulmonary Medicine, Government Medical College and Hospital, Chandigarh, India ABSTRACT We present a case of a 48-year-old male who was diagnosed and treated for Wegener’s granulomatosis on the basis of history, clinical features, computed tomography (CT) and antineutrophil cytoplasmic antibodies (ANCA) positivity. The patient initially improved and later on during course of the disease he was found to be human immunodeficiency virus (HIV) seropositive. The potential pitfalls of cANCA in a HIV-infected patient are discussed. [Indian J Chest Dis Allied Sci 2011;53:55-57] Key words: Wegener's granulomatosis, HIV, ANCA, Radiology. [Received: April 7, 2010; accepted after revision: August 10, 2010] Correspondence and reprint requests: Dr P.R. Mohapatra, Assistant Professor, Department of Pulmonary Medicine, Level-5, Block-D, Government Medical College and Hospital, Sector-32, Chandigarh-160 030, India; Phone: 91-172-2601100; E-mail: prmohapatra@hotmail.com INTRODUCTION Wegener’s granulomatosis is a necrotising granulomatous vasculitis involving respiratory tract and kidneys. The available literature suggests that ANCA are highly specific for Wegener’s granulomatosis. Clinicians use cytoplasmic pattern of ANCA (cANCA) for serologic confirmation of Wegener’s granulomatosis. CASE REPORT A 48-year-old male was admitted to hospital with cough, low-grade fever, minimal haemoptysis and progressive dyspnoea for six weeks. He had taken some treatment for nearly three weeks from a private practitioner but no records were available. Repeated sputum smear examinations were negative for Mycobacterium tuberculosis . On admission, the haemoglobin was 12 gm/dL, total leukocyte counts (TLC) were 17,900/cmm with 64% neutrophils, platelets 2.5 lakh/cmm 3 and the erythrocyte sedimentation rate (ESR) was 47mm at first hour (Westergren). Serum urea and creatinine levels were 20mg/dL and 1.3mg/dL, respectively. Urinalyses (routine and microscopic) was normal. Chest radiograph and CT of thorax at the time of admission are shown in figures 1 and 2, respectively. Based on chest radiograph and CT of thorax, the patient was put on standard antituberculosis treatment (ATT) empirically and bronchoalveolar lavage (BAL) for cytology and acid-fast bacilli (AFB) was planned. Flexible bronchoscopic examination revealed no abnormality up to the level of sub-segmental bronchi. BAL cytology was non-contributory. Wegener’s granulomatosis was considered as next possible differential diagnosis. Subsequently, he was found positive for cANCA by both indirect immunofluorescence and proteinase 3 (PR3) capture assays (quantitative test, kit used- Varelisa™, Phadia GmbH, Freiburg, Germany). Figure 1. Chest radiograph (postero-anterior view) showing left mid-zone consolidation with multiple cavitations.