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ANCA-positive pulmonary granulomatosis in a HER2-positive breast cancer patient on anti-HER2 therapy: case report and literature review

par Collard Vanthournhout, Florian ;Remmelink, Myriam ;Polastro, Laura;Ilzkovitz, Maxime
Référence European journal of case reports in internal medicine
Publication Publié, 2025-05

Article révisé par les pairs

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Résumé :

Introduction: This case highlights the diagnostic complexity of pulmonary granulomatosis in oncology patients, especially when treated with targeted therapy. Case report: We report the case of a 46-year-old female with metastatic HER2-mutated breast cancer who had received multiple lines of HER2-targeted therapies. The patient presented with suspected lung and mediastinal lymph node progression, despite a good response at other affected sites. A lymph node biopsy revealed non-necrotizing pulmonary granulomas, with negative microbiological testing. Further evaluations showed highly elevated anti-PR3 autoantibodies, while angiotensin-converting enzyme (ACE) and calcium levels remained within the normal range. Pulmonary function tests confirmed a restrictive syndrome. Nasal fibroscopy identified chronic sinusitis with massive nasal polyposis, without renal or cutaneous involvement. High-dose corticosteroid therapy was initiated, leading to a favourable response. Based on the clinical presentation, radiological findings, and pathological features, we concluded that the granulomatosis was related to HER2-targeted therapy. Conclusion: This case highlights that both an underlying malignancy and specific drugs—such as HER2-targeted therapy—can occasionally contribute to granuloma formation.