Abstract: Wegener’ s granulomatosis (WG) is a kind of systemic necrotizing granulomatous vasculitis characterized by capillary and small arteriovenous involvement. The typical WG triad is lesions of the upper and lower respiratory tract and kidneys. Only changes in the respiratory tract without renal lesions are localized WG. Localized WG is very easy to bemisdiagnosed because of its nonspecific symptoms and radiological manifestations. The author found one case of localized WG, which showed pulmonary symptoms and refractory heart failure. The chest CT showed that multiple irregular nidus,blurred and density enhanced lesions in both lungs. The patient was misdiagnosed as pulmonary infection for a long time.The patient was eventually diagnosed as asantineutrophil cytoplasmic antibody (ANCA) associated vasculitis and WG after two times of examination of protease -3(PR3) ANCA were positive. This article reviewed the diagnosis and treatment of the patient, and reviewed the relevant literatures.

Key words: vasculitis, Wegener granulomatosis, pneumonia, diagnostic errors, stubborn heart failure