CASE REPORT
Three atypical manifestations of granulomatosis with polyangiitis: lateral medullary syndrome, anterior cheek mass and melting scleritis of eye
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Submission date: 2016-11-24
Final revision date: 2017-01-31
Acceptance date: 2017-05-21
Online publication date: 2017-07-18
Publication date: 2017-06-30
Reumatologia 2017;55(3):145-150
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ABSTRACT
Granulomatosis with polyangiitis (GPA, formerly Wegener granulomatosis) is a vasculitis with various organ involvement. There have been a few cases of CNS stroke and rare cases of lateral medullary infarction (LMI) as a manifestation of GPA. Also there have been reports of sinuses, nose and laryngeal masses mistakenly referred as carcinomas and subsequently GPA was diagnosed in their pathological reports. Another severe fulminant manifestation can be necrotizing scleritis leading to perforation of sclera. Therefore, here we present some rare and fulminant manifestations of GPA in 3 separate cases for further emphasis of the unusual manifestations of GPA that should always be kept in mind.
REFERENCES (16)
1.
Hoffman GS, Kerr GS, Leavitt RY, et al. Wegener granulomatosis: an analysis of 158 patients. Ann Int Med 1992; 116: 488-498.
2.
Sacco RL, Freddo L, Bello JA, et al. Wallenberg’s lateral medullary syndrome. Clinical-magnetic resonance imaging correlations. Archiv Neurol 1993; 50: 609-614.
3.
Gan J, Zheng HB, Xi J, et al. A case of neuro-vasculo-Behcet disease. Europ J Neurol 2007; 14: e16-17.
4.
Shanahan EM, Hutchinson M, Hanley SD, Bresnihan B. Giant cell arteritis presenting as lateral medullary syndrome. Rheumatology (Oxford) 1999; 38: 188-189.
5.
Topalkara K, Kaptanoglu E, Akyuz A, et al. Relapsing polychondritis with involvement of posterior inferior cerebellar artery causing acute lateral medullary syndrome. J Clin Rheumatol 2003; 9: 92-95.
6.
Murphy JM, Gomez-Anson B, Gillard JH, et al. Wegener granulomatosis: MR imaging findings in brain and meninges. Radiology 1999; 213: 794-799.
7.
Bares M, Muchova M, Dufek M, et al. Wegener’s granulomatosis: ischemic stroke as the first clinical manifestation (case study). J Neurol 2002; 249: 1593-1594.
8.
Taraschenko OD, Amory CF, Waldman J, et al. Lateral medullary stroke in patient with granulomatous polyangiitis. J Stroke Cerebrovasc Dis 2014; 23: 1259-1261.
9.
Faust J, Visbeck A, Fitzek S, et al. Vasculitic wallenberg syndrome with detection of anti-proteinase 3 antibodies in the cerebrospinal fluid of a patient with severe Wegener’s granulomatosis and only mild kidney involvement. Nephrol Dial Transplant 2000; 15: 893-896.
10.
Holle JU, Gross WL. Neurological involvement in Wegener’s granulomatosis. Curr Opin Rheumatol 2011; 23: 7-11.
11.
Nagashima T, Maguchi S, Terayama Y, et al. P-ANCA-positive Wegener’s granulomatosis presenting with hypertrophic pachymeningitis and multiple cranial neuropathies: Case report and review of literature. Neuropathology 2000; 1: 23-30.
12.
La Rosa C, Emmanuele C, Tranchina MG, et al. Diagnostic consideration for sinonasal Wegener’s granulomatosis clinically mistaken for carcinoma. Case Rep Otolaryngol 2013; 2013: 839451.
13.
Yanamoto S, Kawasaki G, Yoshida H, et al. Rapidly growing mass of the anterior maxillary gingiva. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 104: 153-159.
14.
Tarabishy AB, Schulte M, Papaliodis GN, Hoffman GS. Wegener’s granulomatosis: clinical manifestations, differential diagnosis, and management of ocular and systemic disease. Surv Ophthalmol 2010; 55: 429-444.
15.
Lu CW, Zhou DD, Wang J, Hao JL. Surgical treatment of peripheral ulcerative keratitis and necrotizing scleritis in granulomatosis with polyangiitis. Saudi Med J 2016; 37: 205-207.
16.
Recillas-Gispert C, Serna-Ojeda JC, Flores-Suarez LF. Rituximab in the treatment of refractory scleritis in patients with granulomatosis with polyangiitis (Wegener’s). Graefes Arch Clin Exp Ophthalmol 2015; 253: 2279-2284.
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