Wegener’s granulomatosis versus pulmonary tuberculosis: a dilemma

The most common cause of bilateral pulmonary cavities with constitutional symptoms in an endemic country like India is pulmonary tuberculosis (PTB). Pulmonary manifestations in systemic vasculitis are very diverse, ranging from nodules, consolidation, and cavity. Wegener’s granulomatosis (WG) is a systemic disease commonly affecting the lungs. Diffuse alveolar hemorrhage (DAH) is a life-threatening and relatively rare pulmonary manifestation of WG. Here, we report a case of a young male diagnosed with WG mimicking PTB with hypoxic respiratory failure who responded to aggressive treatment with cyclophosphamide, high-dose steroids and high-flow nasal cannula support (HFNC).