{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T09:35:54Z","timestamp":1767346554532,"version":"3.48.0"},"reference-count":17,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background and Clinical Significance: Isolated mediastinal lymphadenopathy is an exceptionally rare and diagnostically challenging initial manifestation of microscopic polyangiitis (MPA), often mimicking malignancy or infection. This case highlights the pivotal role of an innovative minimally invasive technique in achieving a definitive diagnosis. To the best of our knowledge, this is the first reported case of MPA diagnosed via EBUS-TMC. Case Presentation: A 55-year-old male livestock farmer from a rural area with a history of recurrent pneumonia presented with four weeks of persistent fever, significant weight loss (7 kg), myalgia, and asthenia. Physical examination revealed fever and cachexia. Notable findings included leukocytosis (17,000\/\u03bcL), normocytic anemia, thrombocytosis (672,000\/\u03bcL), highly elevated inflammatory markers (CRP 145 mg\/L, ESR 120 mm\/h), and strongly positive MPO-ANCA (&gt;134 U\/mL). Serological testing was significant for IgG antibodies against Coxiella burnetii (Phase I 1:64, Phase II 1:256). PET-CT imaging demonstrated hypermetabolic bilateral hilar and mediastinal lymphadenopathy. Diagnostic challenges included overlapping serological findings suggestive of past Coxiella burnetii exposure. Endobronchial ultrasound\u2013guided transbronchial mediastinal cryobiopsy (EBUS-TMC) of a subcarinal lymph node was performed, providing a high-quality sample that revealed neutrophilic small-vessel vasculitis with fibrinoid necrosis, definitive for MPA. Immunosuppressive therapy with high-dose corticosteroids and rituximab (1000 mg on days 1 and 15) was initiated, leading to the complete resolution of all constitutional symptoms. Conclusions: This case illustrates that EBUS-TMC is a safe and highly effective diagnostic tool for obtaining critical histological evidence in systemic vasculitides with atypical presentations. This technique should be considered in the diagnostic algorithm for unexplained mediastinal lymphadenopathy to avoid more invasive surgical procedures.<\/jats:p>","DOI":"10.3390\/diagnostics16010125","type":"journal-article","created":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T09:18:56Z","timestamp":1767345536000},"page":"125","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnosis of Microscopic Polyangiitis by EBUS-Guided Transbronchial Mediastinal Cryobiopsy: A Case Report"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0248-657X","authenticated-orcid":false,"given":"Miriam","family":"Retuerto-Guerrero","sequence":"first","affiliation":[{"name":"Rheumatology Department, Complejo Asistencial Universitario de Le\u00f3n, 24008 Le\u00f3n, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Javier","family":"Juan-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Pulmonology Department, Interventional Pulmonology Unit, Complejo Asistencial Universitario de Le\u00f3n, 24008 Le\u00f3n, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pablo","family":"Franco-Su\u00e1rez","sequence":"additional","affiliation":[{"name":"Pulmonology Department, Interventional Pulmonology Unit, Complejo Asistencial Universitario de Le\u00f3n, 24008 Le\u00f3n, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5671-178X","authenticated-orcid":false,"given":"Samuel","family":"Saez-\u00c1lvarez","sequence":"additional","affiliation":[{"name":"Pathology Department, Complejo Asistencial Universitario de Le\u00f3n, 24008 Le\u00f3n, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8793-0731","authenticated-orcid":false,"given":"Octavio Miguel","family":"Rivero-Lezcano","sequence":"additional","affiliation":[{"name":"Research Unit, Complejo Asistencial Universitario de Le\u00f3n, 24008 Le\u00f3n, Spain"},{"name":"Institute of Biomedicine (IBIOMED), Universidad de Le\u00f3n, 24004 Le\u00f3n, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elvira","family":"D\u00edez-\u00c1lvarez","sequence":"additional","affiliation":[{"name":"Rheumatology Department, Complejo Asistencial Universitario de Le\u00f3n, 24008 Le\u00f3n, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1002\/art.41983","article-title":"2022 American College of Rheumatology\/European Alliance of Associations for Rheumatology classification criteria for microscopic polyangiitis","volume":"74","author":"Suppiah","year":"2022","journal-title":"Arthritis Rheumatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1097\/01.rct.0000135280.79012.c7","article-title":"Thoracic manifestation of myeloperoxidase-Antineutrophil cytoplasmic antibody (MPO-ANCA)-related disease: CT findings in 51 patients","volume":"28","author":"Ando","year":"2004","journal-title":"J. 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Case Rep."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/1\/125\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T09:33:04Z","timestamp":1767346384000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/1\/125"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,1]]},"references-count":17,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["diagnostics16010125"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16010125","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,1]]}}}