# Endobronchial Ulceration: A Different Manifestation of Antineutrophil Cytoplasmic Antibodies (ANCA)-Associated Vasculitis

## TL;DR

A 66-year-old man with GPA showed endobronchial ulcers linked to ANCA-associated vasculitis, treated with immunosuppression and Avacopan.

## Contribution

Highlights endobronchial ulceration as a novel manifestation of GPA and the use of Avacopan in treatment.

## Key findings

- Endobronchial ulcers were observed in a GPA patient during bronchoscopy.
- S. aureus was identified in biopsies, potentially linked to GPA relapses.
- Avacopan was used successfully for GPA and MPA treatment.

## Abstract

Vasculitis with pulmonary involvement is often associated with antineutrophil cytoplasmic antibody (ANCA). We describe a case involving a 66-year-old male patient diagnosed with granulomatosis with polyangiitis (GPA). Following the onset of hemoptysis, bronchoscopy revealed endobronchial ulcers correlated with GPA. Bronchial biopsies and bronchoalveolar lavage identified Staphylococcus aureus (S. aureus), which is associated with GPA relapses. The patient began immunosuppression to induce remission, and Avacopan was subsequently introduced for the treatment of GPA and microscopic polyangiitis (MPA).