Case Report Med Princ Pract 2003;12:133–137 DOI: 10.1159/000069111 Wegener’s Granulomatosis with Parotid Gland Involvement and Pneumothorax YılmazBülbül Tevfik Özlü Funda Öztuna Department of Chest Diseases, Medical School, Karadeniz Technical University, Trabzon, Turkey Received: April 3, 2002 Revised: July 27, 2002 Dr. Yılmaz Bülbül KTU Tıp Fakültesi, Gög ˘üs Hastalıkları Anabilim Dalı 61080 Trabzon (Turkey) Tel. +90 462 3257031/+90 462 3775468 E-Mail ybulbul@meds.ktu.edu.tr ABC Fax + 41 61 306 12 34 E-Mail karger@karger.ch www.karger.com © 2003 S. Karger AG, Basel 1011–7571/03/0122–0133$19.50/0 Accessible online at: www.karger.com/mpp Key Words Hemoptysis W Parotid gland W Pneumothorax W Wegener’s granulomatosis Abstract Objective: Wegener’s granulomatosis is a systemic vas- culitis characterized by necrotizing granulomatous le- sions mostly involving the upper and lower respiratory tract. The disease rarely causes parotid gland involve- ment and pneumothorax. We report a case of Wegener’s granulomatosis involving parotid gland, and compli- cated with a pneumothorax. Clinical Presentation: A 45- year-old man admitted with a 3-week history of painful left parotid gland enlargement and hemoptysis. On physical examination a painful and hard mass was de- tected on the left pre-auricular area. Cervical CT revealed a 2 ! 1.5 cm hypodense lesion mimicking an abscess on the left parotid gland. Chest radiograph and thorax CT demonstrated nodular and cavitating opacities on the right and left upper zones. There were numerous eryth- rocytes in urine sediment. The drained pus material from the parotid abscess demonstrated only gram-positive cocci (Staphylococcus aureus). Two weeks treatment with teicoplanin resulted in no improvement. Mean- while, parotid gland biopsy revealed necrotizing granu- lomatous inflammation. There was a sixfold increase in serum cANCA levels. With the diagnosis of Wegener’s granulomatosis, cyclophosphamide and prednisolone were initiated. However, 1 month later, pneumothorax developed as a complication of rupture of a cavitary lesion. Conclusion: Parotid gland swelling may be the initial presenting symptom of Wegener’s granulomato- sis. It can be confused with infectious or malignant dis- eases of the gland, and the lung involvement may be complicated with pneumothorax. Copyright © 2003 S. Karger AG, Basel Introduction Wegener’s granulomatosis is a systemic vasculitis, characterized by necrotizing granulomatous lesions most- ly involving the upper and lower respiratory tract. It may afflict all organs, but the nose, paranasal sinuses and lungs are the main sites to be affected. Parotid gland involve- ment as an initial presentation is unusual and may be con- fused with other neoplastic and non-neoplastic diseases of the gland [1–6]. Pneumothorax is also a rare complication [7–12]. In this report, we present a case of Wegener’s gran- ulomatosis with parotid gland involvement as a major ini- tial manifestation and with pneumothorax as a complica- tion of cavity rupture.