DOI: 10.12890/2025_005349

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

Authors

  • Florian Collard Vanthournhout Department of Internal Medicine, Jules Bordet Institute, Hôpitaux Universitaires de Bruxelles (H.U.B.), Université Libre de Bruxelles (ULB), Brussels, Belgium
  • Myriam Remmelink Department of Pathology, Jules Bordet Institute, Hôpitaux Universitaires de Bruxelles (H.U.B.), Université Libre de Bruxelles (ULB), Brussels, Belgium
  • Laura Polastro Department of Medical Oncology, Jules Bordet Institute, Hôpitaux Universitaires de Bruxelles (H.U.B.), Université Libre de Bruxelles (ULB), Brussels, Belgium
  • Maxime Ilzkovitz Department of Internal Medicine, Jules Bordet Institute, Hôpitaux Universitaires de Bruxelles (H.U.B.), Université Libre de Bruxelles (ULB), Brussels, Belgium

maxime.ilzkovitz@hubruxelles.be

Keywords

Sarcoid-like reaction, sarcoidosis, granuloma, HER2, ANCA

Abstract

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.

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The pulmonary computed tomography-scan reveals resolution of the bilateral nodular infiltration after corticosteroid therapy.

Published

2025-05-09

Issue

Vol. 12 No. 6 (2025)

Categories

How to Cite

1.
Collard Vanthournhout F, Remmelink M, Polastro L, Ilzkovitz M. ANCA-positive pulmonary granulomatosis in a HER2-positive breast cancer patient on anti-HER2 therapy: case report and literature review. EJCRIM [Internet]. 2025 May 9 [cited 2026 Nov. 4];12(6). Available from: https://ejcrim.com/index.php/ejcrim/article/view/5349

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