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Koritala T, Mene-Afejuku TO, Schaefer M, Dondapati L, Pleshkova Y, Yasmin F, Mushtaq HA, Khedr A, Adhikari R, Al Mutair A, Alhumaid S, Rabaan AA, Al-Tawfiq JA, Jain NK, Khan SA, Kashyap R, Surani S. Granulomatous Polyangiitis With Renal Involvement: A Case Report and Review of Literature. Cureus 2021; 13:e19814. [PMID: 34963834 PMCID: PMC8695666 DOI: 10.7759/cureus.19814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 11/22/2021] [Indexed: 12/02/2022] Open
Abstract
Granulomatosis with polyangiitis (GPA), formerly named Wegner’s granulomatosis is an antineutrophilic cytoplasmic antibody (ANCA) associated vasculitis of the small vessels. GPA can affect several organ systems even though predominantly affects respiratory and renal systems. Pathogenesis is initiated by activation of the immune system to produce ANCA, Cytoplasmic (C-ANCA) antibody, which thereby leads to widespread necrosis and granulomatous inflammation. Multisystem involvement with varied symptomatology makes GPA diagnosis more challenging. Early diagnosis and management are vital and can alter the prognosis of the disease. We present a literature review and a clinical scenario of a 26-year-old male with a history of chronic sinusitis, testicular carcinoma in remission, recent onset of worsening cough, epistaxis, hoarseness of voice, weight loss, and dark-colored urine. Workup revealed high titers of C-ANCA, C-reactive protein, procalcitonin, CT chest evidence of mass-like consolidation, and bronchoscopy findings of friable tissue that was not amenable for biopsy. Methylprednisolone and rituximab (RTX) were administered, which resulted in marked clinical improvement. Therefore, a keen eye for details is necessary to diagnose GPA early, which can improve disease outcomes dramatically.
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Affiliation(s)
| | | | | | - Lavanya Dondapati
- Internal Medicine, Dr. N.T.R University of Health Sciences, Vijayawada, IND
| | | | - Farah Yasmin
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | | | - Anwar Khedr
- Critical Care Medicine, Mayo Clinic, Mankato, USA.,Medicine, Tanta University Faculty of Medicine, Tanta, EGY
| | - Ramesh Adhikari
- Hospital Medicine, Franciscan Health, Lafayette, USA.,Geriatrics, Brown University, Providence, USA
| | - Abbas Al Mutair
- Emergency Medicine, Almoosa Specialist Hospital, Al-Ahsa, SAU
| | - Saad Alhumaid
- Pharmaceutical Care, Al-Ahsa Health Cluster, Al-Ahsa, SAU
| | - Ali A Rabaan
- Molecular Microbiology, Johns Hopkins Aramco Healthcare, Dhahran, SAU
| | | | | | | | - Rahul Kashyap
- Anesthesiology and Critical Care, Mayo Clinic, Rochester, USA
| | - Salim Surani
- Anesthesiology, Mayo Clinic, Rochester, USA.,Medicine, Texas A&M University, College Station, USA.,Medicine, University of North Texas Dallas, Dallas, USA.,Internal Medicine, Pulmonary Associates of Corpus Christi, Corpus Christi, USA.,Clinical Medicine, University of Houston, Houston, USA
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2
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Basetti B, Periakaruppan G, Murali A, Dev B, Radhakrishnan PR, Sai PMV. Breast involvement in granulomatosis with polyangiitis: a case report. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00569-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Granulomatosis with polyangiitis (GPA) previously known as Wegener's granulomatosis is a rare complex immune-mediated disease and a multisystem disorder with varying presentations where many of the imaging features of GPA overlap with those of other diseases, and hence its diagnosis can be challenging.
Case presentation
Here we report a case of a 48-year-old female who presented with complaints of hemoptysis, difficulty in speech, bilateral progressive hearing loss and, a palpable lump in the right breast. The case was initially misdiagnosed as breast carcinoma but biopsy proved to be GPA. Here we present the multisystem manifestations of GPA involving the head and neck, breast, lungs, spleen with involvement of the breast being very rare. The breast lesion showed improvement with steroids on follow-up.
Conclusions
GPA is a multisystem disease and though breast lesions in GPA are rare, a thorough knowledge about this uncommon manifestation is required and clinical, radiological, and histopathological correlation is of utmost importance in the evaluation of a breast lesion in cases of multisystem involvement to avoid unnecessary surgeries. The differential diagnosis of breast tumors should include such rare conditions that can sometimes mimic breast cancer. Early diagnosis and initiation of the immunosuppressive treatment help in a better prognosis of the disease.
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BAŞAK N, ÖZGÜRSOY URAN B. Nadir Görülen Bir Hastalık: Granülomatozisli Polianjitis Olgusu. DÜZCE ÜNIVERSITESI SAĞLIK BILIMLERI ENSTITÜSÜ DERGISI 2020. [DOI: 10.33631/duzcesbed.691026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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4
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Kısacık B, Önder ME, Sayarlıoğlu M, Onat AM. Symmetric polyarthritis as an initial symptom in granulomatosis with polyangiitis: A report of six cases and review of the literature. Eur J Rheumatol 2018; 5:191-193. [PMID: 30071923 DOI: 10.5152/eurjrheum.2018.17050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 03/26/2018] [Indexed: 11/22/2022] Open
Abstract
Granulomatosis with polyangiitis (GPA) is a primary systemic vasculitis characterized by granulomatous inflammation. Arthritis in GPA is most commonly associated with large joints, particularly the knees and ankles; however, symmetrical polyarthritis of small joints has been rarely reported in literature. Here, we describe retrospective analysis of six patients with GPA showing initial symptom of symmetrical polyarthritis who were followed-up by three different rheumatology departments. Male sex, anti-cyclic citrulinated peptide negativity, and early arthritis period are important clues for GPA.
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Affiliation(s)
- Bünyamin Kısacık
- Department of Rheumatology, Medical Park Gaziantep Hospital, Gaziantep, Turkey
| | - Mustafa Erkut Önder
- Department of Rheumatology, Mersin University School of Medicine, Mersin, Turkey
| | - Mehmet Sayarlıoğlu
- Department of Rheumatology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
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Li J, Li C, Li J. Thoracic manifestation of Wegener's granulomatosis: Computed tomography findings and analysis of misdiagnosis. Exp Ther Med 2018; 16:413-419. [PMID: 29896268 DOI: 10.3892/etm.2018.6154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 01/18/2018] [Indexed: 12/11/2022] Open
Abstract
The aim of the present study was to investigate the computed tomography (CT) manifestations of Wegener granulomatosis (WG) in the chest and potential reasons for misdiagnosis. Conventional CT scans and clinical data of 45 patients with WG were retrospectively analyzed. Patients typically presented with multiple system involvement, primarily in the upper and lower respiratory tract. The incidence of thoracic involvement was 75.56% (34/45). Radiographic features were varied between cases in the present study, with the most common features being numerous cavitary nodules and masses in the lungs. Cavitations were usually irregular, with uneven wall thickness, partial centrality, fuzzy inner edges and piecemeal necrosis. These results indicate that WG typically has multiple system involvement, with the chest being most prominent. Multiple variable-sized cavitary nodules with irregular edges and piecemeal necrosis were the most notable features revealed using CT scanning; however, in order to give a definitive diagnosis, biopsies should be performed.
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Affiliation(s)
- Jiakai Li
- Department of Radiology, The Hainan Branch of The Chinese PLA General Hospital, Sanya, Hainan 572013, P.R. China.,Department of Radiology, The Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Chuangui Li
- Department of Radiology, The First Affiliated Hospital, Northern Hebei College, Zhangjiakou, Hebei 075000, P.R. China
| | - Jiaojiao Li
- Department of Radiology, The General Hospital, Tianjin Medical University, Tianjin, Hebei 300052, P.R. China
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Ito K, Minamimoto R, Yamashita H, Yoshida S, Morooka M, Okasaki M, Mimori A, Kubota K. Evaluation of Wegener's granulomatosis using 18F-fluorodeoxyglucose positron emission tomography/computed tomography. Ann Nucl Med 2012; 27:209-16. [PMID: 23242952 PMCID: PMC3618408 DOI: 10.1007/s12149-012-0675-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Accepted: 12/04/2012] [Indexed: 12/21/2022]
Abstract
Objective Wegener’s granulomatosis (WG) is a relatively rare disease characterized by granulomatous necrotizing vasculitis that primarily involves small- and medium-sized vessels. Systemic findings observed on 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) have not been well reported. The purpose of this study was to evaluate the FDG PET/CT imaging in the diagnosis and follow-up of patients with WG. Materials and methods Thirteen FDG PET/CT images obtained for 8 patients (2 men and 6 women) with WG were retrospectively analyzed. Of these, 6 were performed for diagnosis, 2 for restaging and follow-up, and 5 for assessment of treatment efficacy. Maximum standardized uptake values (max SUVs) and visual analyses were used to interpret the FDG PET/CT images. In addition, nonenhanced CT findings obtained during FDG PET/CT were described. Results WG lesions of the upper respiratory tract and lung were more clearly detected by FDG PET/CT fusion imaging than by nonenhanced CT alone, and all of the active lesions showed decreased FDG uptake after treatment. In addition, FDG PET/CT can provide complementary information to indicate biopsy site based on FDG uptakes. Conclusions FDG PET/CT is a feasible modality for evaluating lesion activities, therapeutic monitoring, and follow-up of WG. Furthermore, biopsy sites of WG lesions may be determined by FDG PET/CT.
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Affiliation(s)
- Kimiteru Ito
- Department of Radiology, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo 187-8551, Japan.
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Martinez F, Chung JH, Digumarthy SR, Kanne JP, Abbott GF, Shepard JAO, Mark EJ, Sharma A. Common and Uncommon Manifestations of Wegener Granulomatosis at Chest CT: Radiologic-Pathologic Correlation. Radiographics 2012; 32:51-69. [DOI: 10.1148/rg.321115060] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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8
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Knopf A, Bas M, Chaker A, Strassen U, Pickhard A, Stark T, Lahmer T, Thurmel K. Rheumatic disorders affecting the head and neck: underestimated diseases. Rheumatology (Oxford) 2011; 50:2029-34. [DOI: 10.1093/rheumatology/ker213] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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9
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[Epistaxis and systemic disease]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2009; 60:456-8. [PMID: 19909723 DOI: 10.1016/j.otorri.2008.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Accepted: 11/28/2008] [Indexed: 10/20/2022]
Abstract
We report the case of a 77-year-old man who presented nasal obstruction sensation and epistaxis. Otorhinolaryngological examination revealed occupation of the left nasal passage and the left maxillary sinus by an inflammatory tumour, the biopsy results of which were inconclusive. While diagnostic tests where being carried out, the patient presented a severe systemic condition consisting mainly of anaemia, acute renal failure, and cavitated diffuse bilateral lung infiltrates. In the light of the results of anti-neutrophilic cytoplasmic antibodies and renal biopsy, Wegener's granulomatosis was diagnosed and treatment for the disease was instituted with a favourable response. Finally, clinical manifestations of Wegener's granulomatosis are reviewed, with especial emphasis on otolaryngologic complaints.
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Roca B. Epistaxis and systemic disease. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2009. [DOI: 10.1016/s2173-5735(09)70175-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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De Coster C, Fitzgerald A, Cepoiu M. Priority-setting tools for rheumatology disease referrals: a review of the literature. Clin Rheumatol 2008; 27:1411-6. [PMID: 18560920 DOI: 10.1007/s10067-008-0938-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Revised: 05/07/2008] [Accepted: 05/13/2008] [Indexed: 10/21/2022]
Abstract
As part of a larger body of work to develop a rheumatology priority referral score, a literature review was conducted. The objective of the literature review was to identify preexisting priority-setting, triage, and referral tools/scales developed to guide referrals from primary care to specialist care/consultation usually provided by a rheumatologist. Using a combination of database, citation, Internet, and hand-searching, 20 papers were identified that related to referral prioritization in three areas: rheumatoid arthritis (RA; 5), musculoskeletal (MSK) diseases other than RA (3), and MSK diseases in general (12). No single set of priority-setting criteria was identified for rheumatologic disorders across the spectrum of patients who may be referred from primary care providers (PCPs) to rheumatologists. There appears to be more congruence on conditions at either end of the urgency spectrum with conditions such as suspected cranial arteritis or systemic vasculitis deemed to be emergency referrals and fibromyalgia and other soft-tissue syndromes deemed to be more routine referrals. Between these two extremes, there is a divergence of opinion about urgency and few papers on the issue. The exception to this is referral for early RA for which several criteria have been established. Despite the inherent complexities in developing a tool to prioritize patients referred by PCPs to rheumatologists, there are compelling reasons to proceed. With the aging of the population, the number of patients being referred to rheumatologists is expected to increase. With pharmaceutical advances, there are demonstrable benefits in early referral for some conditions. These trends have led to increased pressure on scarce rheumatological human resources. A tool to prioritize referrals is a critical component of improving access and the referral process.
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