A 48-year-old female presents with recurrent epistaxis, microscopic hematuria, cough, and bilateral cavitary pulmonary nodules on chest CT. Serum testing reveals positive c-ANCA (anti-proteinase 3). What is the primary pathologic finding expected on tissue biopsy?

Answer and explanation

Correct answer: B. Necrotizing granulomatous vasculitis of small vessels

  1. Step 1: Upper airway, lung (cavitary lesions), and renal involvement (glomerulonephritis) with positive c-ANCA/PR3-ANCA is classic for Granulomatosis with Polyangiitis (GPA).
  2. Step 2: Diagnostic histopathology demonstrates necrotizing granulomatous inflammation of small-to-medium vessels with microabscesses.
  3. Step 3: Linear IgG is pathognomonic for Goodpasture disease; non-caseating sarcoid granulomas lack necrotizing vasculitis.
Answer
Necrotizing granulomatous vasculitis of small vessels.
Why not the others: Linear IgG is Goodpasture syndrome; sarcoidosis lacks c-ANCA and necrotizing vasculitis; isolated cutaneous vasculitis lacks systemic granulomas.

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