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A 50-year-old woman presented with fatigue, weight loss, and arthralgia in her hands and feet. Her medical history was notable for hypothyroidism, prior House–Brackmann grade III facial paralysis, and a serologically and radiologically confirmed type 5 hepatic cystic echinococcosis (CE) (Fig. 1A). One year earlier, she had been hospitalized for hemoptysis. Thoracic imaging revealed a 34 × 52 × 23 mm cavitary mass with cystic and necrotic components in the posterior basal segment of the right lower lobe, along with multiple non-calcified pulmonary nodules (Fig. 1B, C). Considering her hepatic CE, a rupture-related reactive process was initially suspected. The patient underwent wedge resection followed by antiparasitic therapy, and histopathology had demonstrated a cavitary lesion with necrosis, acute and granulomatous inflammation, microabscesses, eosinophilic infiltration, multinucleated giant cells, and organizing pneumonia. Ziehl–Neelsen staining and microbiological cultures were negative.
Fig. 1
A Axial abdominal computed tomography demonstrating an 18-mm, well-defined subcapsular lesion in liver segment 5 with complete wall calcification (arrow), imaging features typical of an inactive hepatic hydatid cyst (CE5 stage). B Thorax CT revealing a large cavitary lesion with central necrosis in the posterior basal segment of the right lower lobe. C The FDG PET-CT image illustrates thick-walled cavitary lesions in the right lower lobe, showing increased FDG uptake; nearby nodules have mild or no uptake. D Histopathological examination showing necrotizing vasculitis of a small- to medium-sized vessel, characterized by luminal thrombosis, destruction of the vessel wall, and prominent perivascular inflammatory infiltrates. These findings are consistent with granulomatosis with polyangiitis (hematoxylin and eosin stain, original magnification × 200)
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