CASE REPORT
The variety of clinical symptoms as a cause of difficulty in correct diagnosis of granulomatosis with polyangiitis
Submission date: 2013-08-14
Final revision date: 2014-01-19
Acceptance date: 2014-02-05
Online publication date: 2014-03-23
Publication date: 2014-02-28
Reumatologia 2014;52(1):77-81
KEYWORDS
TOPICS
Vasculitis - aetiology, pathogenesis, clinical features and treatmentDiagnostics and imaging in rheumatic diseases
ABSTRACT
The essence of granulomatosis with polyangiitis (GPA) is the occurrence of necrotizing granulomatous vasculitis of medium and small vessels. Particularly, the respiratory tract and the kidneys are predisposed to this disease.
We present the case of a 65-year-old woman in whom GPA was diagnosed. The occurrence of non-specific clinical signs contributed to the fact that the disease remains undiagnosed for a long time. The predominant symptom was treatment-resistant, long-term skin ulceration in the right leg.
No therapeutic effect of long-term treatment of ulcers should lead to further evaluation and a search for other causes of symptoms. Implementation of effective treatment prevents complications in GPA, which is possible by establishing a rapid diagnosis.
We present the case of a 65-year-old woman in whom GPA was diagnosed. The occurrence of non-specific clinical signs contributed to the fact that the disease remains undiagnosed for a long time. The predominant symptom was treatment-resistant, long-term skin ulceration in the right leg.
No therapeutic effect of long-term treatment of ulcers should lead to further evaluation and a search for other causes of symptoms. Implementation of effective treatment prevents complications in GPA, which is possible by establishing a rapid diagnosis.
REFERENCES (22)
1.
Nowak K, Dutkiewicz W, Icek W i wsp. A case of cardiac rupture in Wegener’s granulomatosis. Kardiochir Torakochir Pol 2011; 4: 500-503.
3.
Langford CA, Hoffman GS. Rare diseases. 3: Wegener’s granulomatosis. Thorax 1999; 54: 629-637.
4.
Benendo-Kapuścińska B, Święcicka D, Wojciechowski A, Decker E. Ziarniniakowatość Wegenera – obraz kliniczny, rozpoznanie, metody diagnostyczne. Pol Przegl Radiol 2000; 65: 57-61.
5.
Fauci AS, Haynes BF, Katz P, Wolff SM. Wegener’s granulomatosis: prospective clinical and therapeutic experience with 85 patients for 21 years. Ann Intern Med 1983; 98: 76-85.
6.
Kur-Zalewska J, Tłustochowicz W. Zapalenia małych naczyń. W: Wielka Interna. Vol. 9. Puszczewicz M (red.). Medical Tribune, Warszawa 2010; 192-213.
7.
Horn RG, Fauci AS, Rosenthal AS, Wolff SM. Renal biopsy pathology in Wegener’s granulomatosis. Am J Pathol 1974; 74: 423-440.
9.
Rowińska-Zakrzewska E, Wiatr E, Pirożyński M. Choroby śródmiąższowe płuc. a-medica press, Warszawa 2001; 206-215.
10.
Wawrzyńska L, Sawionek I, Filipecki S. Ziarniniakowatość Wegenera. Opis trzech przypadków o odmiennym obrazie klinicznym. Pneumonol Alergolog Pol 1996; 64: 78-84.
11.
Słowiński P, Krosny T, Raciborski W, Staszkiewicz W. Współczesne poglądy na powstawanie i leczenie żylnych owrzodzeń podudzi. Postępy Nauk Med 2012; supl. 3: 27-34.
12.
Pitsch T, Grzanka A, Legaszewski T, Rogala B. Ziarniniakowatość Wegenera maskowana objawami przewlekłego alergicznego nieżytu nosa. Alergia Astma Immunologia 2004; 9: 209-212.
14.
Endoxan – charakterystyka produktu leczniczego: http://baxter.com.pl/downloads... Oncology/Endoxan_50mg.pdf.
15.
Tarasewicz A, Bułło B, Majewski A, Rutkowski B. Trudności terapeutyczne u pacjentki z ziarninia-kowatością Wegenera leczonej przewlekle hemodializami – opis przypadku. Forum Nefrologiczne 2012; 5: 1.
16.
The Benefits of Transplant Dialysis: http://www.bidmc.org/Centers-a... Departments/ Transplant-Institute/Kidney/The-Benefits-of-Transplant versus Dialysis.aspx.
17.
Haubitz M, Kliem V, Koch KM, et al. Renal transplantation for patients with autoimmune diseases: single-center experience with 42 patients. Transplantation 1997; 63: 1251-1257.
18.
Fauci AS, Balow JE, Brown R, et al. Successful renal transplantation in Wegener’s granulomatosis. Am J Med 1976; 60: 437-440.
19.
Allen A, Pusey C, Gaskin G. Outcome of renal replacement therapy in antineutrophil cytoplasmic antibody associated systemic vasculitis. J Am Soc Nephrol 1998; 9: 1258-1263.
20.
Nachman PH, Segelmark M, Westman K, et al. Recurrent ANCA-associated small vessel vasculitis after transplantation: a pooled analysis. Kidney Int 1999; 56: 1544-1550.
21.
Haubitz M, Koch KM, Brunkhorst R. Survival and vasculitis activity in patient with end stage renal disease due to Wegener’s granulomatosis. Nephrol Dial Transplant 1998; 13: 1713-1718.
22.
Gera M, Griffin MD, Specks U, et al. Recurrence of ANCA-associated vasculitis following renal transplantation in the modern era of immunosuppression. Kidney Int 2007; 71: 1296-1301.
Copyright: © Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji w Warszawie. This is an Open Access journal, all articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (https://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
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| ISSN: | 0034-6233 |
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