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Krukov AI, Kirasirova EA, Piminidi OK, Rezakov RA, Lafutkina NV, Mamedov RF. [The modern approach to the treatment of subglottic laryngeal stenosis]. Vestn Otorinolaringol 2018; 83:52-55. [PMID: 29488498 DOI: 10.17116/otorino201883152-55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
UNLABELLED The objective of the present study was to optimize the treatment of patients with subglottic laryngeal stenosis. MATERIAL AND METHODS We have examined a total of 14 patients presenting with subglottic laryngeal stenosis. The etiological factors and underlying conditions of laryngeal stenosis were the prolonged intubation in 4 patients, Wegener granulomatosis in 6 patients, and idiopathic stenosis of the larynx in 4 patients. All the patients underwent balloon dilatation with the application of the video endoscopic technique. RESULTS The surgical treatment of all the patients made it possible to achieve the persistent expansion of the lumen of the subglottic part of the larynx, to shorten the periods of the in-patient treatment and rehabilitation of the patients. Restenosis of laryngeal lining stenting was observed in one patient presenting with Wegener's granulomatosis which was associated with the relapse of the underlying disease.
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Abstract
A 77-year-old Japanese woman presented to an ophthalmologist with an erythematous swollen upper eyelid and diplopia which was initially diagnosed to be idiopathic dacryoadenitis on the basis of a histological evaluation of an orbital mass that was in remission following a 3.5-month period of systemic corticosteroid therapy. She subsequently developed respiratory symptoms, and was finally diagnosed with systemic granulomatosis with polyangiitis (GPA) based on the clinical and histological features. She was successfully treated with corticosteroids and azathioprine. Dacryoadenitis in the form of an orbital inflammatory pseudotumor may be an initial presenting feature of GPA, sometimes as the limited phenotype, and occasionally progressing to systemic disease.
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Shi XH, Zhang YF, Lu YW. Successful treatment of granulomatosis with polyangiitis with hydropneumothorax using corticosteroids and immunosuppressant. Exp Ther Med 2017; 13:3586-3590. [PMID: 28588684 DOI: 10.3892/etm.2017.4440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 02/10/2017] [Indexed: 11/06/2022] Open
Abstract
Pneumothorax and pleural effusion is a rare and serious complication of granulomatosis with polyangiitis (GPA). The present study reported a case with a history of sinusitis for 20 years, dry cough for three years and exacerbated purulent nasal discharge and recurrent skin ulcers for two years. The patient experienced sudden difficulty in breathing two months prior to presentation. Lung computed tomography (CT) showed multiple bilateral lung nodules and cavitary nodules as well as right hydropneumothorax. Paranasal sinus CT showed soft tissue infiltration. The cytoplasmic pattern of anti-neutrophil cytoplasmic antibody (c-ANCA) was positive and anti-proteinase 3 (PR3) antibodies, erythrocyte sedimentation rate and C-reactive protein were elevated. After pleural drainage and methylprednisolone pulse treatment, followed by cyclophosphamide and cyclosporine, the patient's symptoms were ameliorated, lungs were re-expanded, and c-ANCA, PR3 and inflammatory markers returned to normal levels.
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Contrast-enhanced ultrasound and computed tomography findings of granulomatosis with polyangiitis presenting with multiple intrarenal microaneurysms: A case report. Clin Imaging 2017; 43:144-147. [PMID: 28319866 DOI: 10.1016/j.clinimag.2017.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 02/25/2017] [Accepted: 03/07/2017] [Indexed: 11/23/2022]
Abstract
Granulomatosis with polyangiitis (GPA) is a systemic disorder that affects small- and medium- sized vessels in many organs. Although the kidneys are the second most commonly involved organ in patients with GPA, its manifestation as multiple intrarenal aneurysms is rare. We report an unusual manifestation of GPA with multiple intrarenal microaneurysms, as demonstrated by contrast-enhanced ultrasound and computed tomography.
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Fonseca FP, Benites BM, Ferrari A, Sachetto Z, de Campos GV, de Almeida OP, Fregnani ER. Gingival granulomatosis with polyangiitis ( Wegener's granulomatosis) as a primary manifestation of the disease. Aust Dent J 2016; 62:102-106. [PMID: 27439744 DOI: 10.1111/adj.12441] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2016] [Indexed: 01/20/2023]
Abstract
Granulomatosis with polyangiitis (GPA) is a potentially lethal disease characterized by systemic necrotizing vasculitis, which affects small- and medium-sized blood vessels and is often associated with serum cytoplasmic antineutrophil cytoplasmic antibody. The upper and lower respiratory tract and kidney are the most involved sites, but oral lesions can be identified in 6-13% of the cases, whereas in only 2% of the cases, oral manifestations represent the first signal of the disease usually as gingival swellings or unspecific ulcerations. Without treatment, the mainstay of which is the combination of immunosuppressants and systemic corticosteroids, GPA may run a fatal course. In this report we describe an original case of GPA affecting a 75-year-old female patient referred to our service due to a gingival swelling with 3-month duration. Although the patient was correctly diagnosed and promptly treated, she died 3 months after the initial diagnosis.
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Falk L, Broman LM. Extracorporeal membrane oxygenation rescue in adolescent with bronchiolitis obliterans-organizing pneumonia like Wegener's granulomatosis. Clin Case Rep 2016; 5:29-34. [PMID: 28096986 PMCID: PMC5224776 DOI: 10.1002/ccr3.752] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/18/2016] [Accepted: 11/03/2016] [Indexed: 01/15/2023] Open
Abstract
We report a 17-year-old woman with bronchiolitis obliterans-organizing pneumonia (BOOP)-like granulomatosis with polyangiitis developing severe airway obliterations. Pending age, phase and grade of autoimmune treatment, and offering ECMO treatment may be crucial for survival but occasionally preface futility. ECMO-treated patient with BOOP-like GPA has never been described before.
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Mohapatra A, Khan T, Diaz J, Brasington R, Zebala LP. Granulomatosis with polyangiitis ( Wegener's granulomatosis) causing atlantoaxial instability: a case report. Spine J 2016; 16:e717-e720. [PMID: 27179623 DOI: 10.1016/j.spinee.2016.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 03/04/2016] [Accepted: 05/07/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT No previous cases of atlantoaxial instability due to granulomatosis with polyangiitis have been reported. PURPOSE The aim of this study was to report a case of granulomatosis with polyangiitis causing atlantoaxial instability. STUDY DESIGN This is a case report. PATIENT SAMPLE A 45-year-old woman participated in this study. OUTCOME MEASURES The patient's pain and atlantoaxial instability were resolved. METHODS A 45-year-old Caucasian woman with a large ulcerative lesion in her oropharynx initially presented with chronic sinusitis, pharyngitis, and severe odynophagia. Years after her original symptoms began, she developed neck pain radiating into her upper trapezial region and shoulders. RESULTS Atlantoaxial fusion was performed on the patient, resolving her neck, upper trapezial, and shoulder pain. She was diagnosed with granulomatosis with polyangiitis (formerly Wegener's granulomatosis) and treated with cyclophosphamide. CONCLUSIONS Granulomatosis with polyangiitis should be part of the working differential diagnosis for non-traumatic cervical spine injury. The atlantoaxial instability can be managed with stabilization, and the disease process itself can be treated with cyclophosphamide.
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Lee PY, Adil EA, Irace AL, Neff L, Son MBF, Lee EY, Perez-Atayde A, Rahbar R. The presentation and management of granulomatosis with polyangiitis ( Wegener's Granulomatosis) in the pediatric airway. Laryngoscope 2016; 127:233-240. [PMID: 27113905 DOI: 10.1002/lary.26013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 02/19/2016] [Accepted: 03/04/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Granulomatosis with polyangiitis (GPA) is a necrotizing inflammatory disease that can affect the airway. The purpose of this study was to present a case of pediatric laryngotracheal GPA and provide management recommendations based on a thorough review of the literature. DATA SOURCES Retrospective chart and literature review REVIEW METHODS: A pediatric patient with laryngotracheal and pulmonary manifestations of GPA who underwent chemotherapy and intralesional corticosteroid injection is described. An extensive literature review of pediatric GPA affecting the larynx/trachea was also performed. RESULTS A pediatric patient presented with acute respiratory distress. Flexible laryngoscopy revealed a laryngeal mass. Magnetic resonance imaging showed circumferential subglottic stenosis, and chest computed tomography demonstrated multiple pulmonary nodules. Laryngeal and tracheal biopsy revealed granulation tissue and primary vasculitis. Labs demonstrated positive cytoplasmic antineutrophil cytoplasmic antibody, consistent with GPA. Methylprednisone, rituximab, cyclophosphamide, and intralesional steroid injection resulted in remission after 12 weeks. Review of the literature revealed two pediatric cases series and 10 case reports of GPA affecting the larynx or trachea. CONCLUSIONS There is a higher prevalence of GPA of the airway in children when compared to adults. Biopsy of the airway lesion may not be necessary and has lower diagnostic yield compared to other GPA subsites. Medical management includes induction therapy followed by maintenance therapy once the disease is in remission. Most patients will require a surgical intervention to maintain the airway. LEVEL OF EVIDENCE NA Laryngoscope, 127:233-240, 2017.
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Orbital tumour due rhinosinusal extension in a patient with Wegener's granulomatosis. ACTA ACUST UNITED AC 2016; 91:442-5. [PMID: 27017537 DOI: 10.1016/j.oftal.2016.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 02/15/2016] [Accepted: 02/17/2016] [Indexed: 11/22/2022]
Abstract
CASE REPORT The case is presented of a 49 year-old woman with an orbital mass originating from the rhinosinus. She had a history of Wegener's granulomatosis, refractory to both biological and immunosuppressive therapy. Clinical examination showed proptosis, diplopia, and restriction of ocular movements. DISCUSSION Orbital mass resection was performed, due to its rapid growth, and lack of response to medical treatment.
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Iannella G, Greco A, Granata G, Manno A, Pasquariello B, Angeletti D, Didona D, Magliulo G. Granulomatosis with polyangiitis and facial palsy: Literature review and insight in the autoimmune pathogenesis. Autoimmun Rev 2016; 15:621-31. [PMID: 26851550 DOI: 10.1016/j.autrev.2016.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 02/01/2016] [Indexed: 01/28/2023]
Abstract
Granulomatosis with polyangiitis (GPA) is an autoimmune systemic necrotizing small-vessel vasculitis associated with the presence of anti-neutrophil cytoplasmic antibodies (ANCA). Oto-neurological manifestations of ANCA-associated vasculitis according to PR3-ANCA positivity and MPO-ANCA positivity are usually reported. Facial nerve palsy is usually reported during the clinical course of the disease but it might appear as the presenting sign of GPA. Necrotizing vasculitis of the facial nerve 'vasa nervorum' is nowadays the most widely accepted etiopathogenetic theory to explain facial damage in GPA patients. A central role for PR3-ANCA in the pathophysiology of vasculitis in GPA patients with oto-neurological manifestation is reported. GPA requires prompt, effective management of the acute and chronic manifestations. Once the diagnosis of GPA has been established, clinicians should devise an appropriate treatment strategy for each individual patient, based on current clinical evidence, treatment guidelines and recommendations.
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Liu X, Cui Y, Li Y, Wang C, Zhao H, Han J. Using inpatient data to estimate the prevalence of Wegener's granulomatosis in China. Intractable Rare Dis Res 2016; 5:31-5. [PMID: 26989646 PMCID: PMC4761581 DOI: 10.5582/irdr.2015.01015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
China lacks a registry for most rare diseases, so specific epidemiological data on those diseases are lacking. A strategy involving the DISMOD II model was recently formulated to estimate the epidemiological parameters of rare diseases, and this strategy has been used to study several rare diseases. The current study used this strategy to estimate the prevalence of one such rare disease, Wegener's granulomatosis (WG), in China based on its incidence, mortality, and rate of remission according to the software tool DISMOD II. The incidence of WG was calculated based on inpatient data from 100 hospitals throughout China. The cause-specific mortality from WG was estimated based on data from the National Vital Statistics System of the United States and adjusted for the Chinese population. The rate of disease remission was based on the results of previous study. The current results indicated that the prevalence of WG in China is 1.94/100,000, which is slightly lower than that in Europe and the United States. The mean age at onset of WG in China was calculated to be 38.9 years for males and 39.3 years for females and the duration of disease was 28 years for both male and female patients. These figures are similar to published data from other countries. In conclusion, the DISMOD II model was used to estimate the prevalence of WG in China, providing a basis to evaluate the potential disease burden and orphan drug use by patients with WG. The DISMOD II model could be used to estimate the prevalence of other rare diseases.
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Horta-Baas G, Hernández-Cabrera MF, Catana R, Pérez-Cristóbal M, Barile-Fabris LA. Subglottic stenosis in granulomatosis with polyangiitis ( Wegener's granulomatosis): Report of 4 cases. ACTA ACUST UNITED AC 2015; 12:267-73. [PMID: 26718390 DOI: 10.1016/j.reuma.2015.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 10/25/2015] [Accepted: 10/30/2015] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Subglottic stenosis (SGS) in granulomatosis with polyangiitis (GPA) may result from active disease or from chronic recurrent inflammation. The objective of the study was to describe the clinical features and treatment of patients with subglottic stenosis. METHODS We retrospectively reviewed the medical records of all patients with SGS due to GPA diagnosed at Rheumatology deparment between January 2000 and June 2015. RESULTS We present 4 cases of SGS at our department during a period of 15 years. The interval between the presentation of the GPA and SGS varied between 2 and 144 months. The leading symptoms of SGS were dyspnoea on exertion and stridor. Three patients presented SGS without evidence of systemic activity. Two patients presented SGS grade i and received tracheal dilatation; two recurred and three needed a tracheostomy due to severe airway-limiting stenosis. CONCLUSION SGS presents high morbidity. Even though subglottic dilatation provides symptomatic relief, recurrences may present. Severe airway-limiting stenosis often requires tracheostomy.
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Wu J, Niu JK, Miao YL. Ischemic bowel disease associated with granulomatosis with polyangiitis: A case report. Shijie Huaren Xiaohua Zazhi 2015; 23:4765-4770. [DOI: 10.11569/wcjd.v23.i29.4765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Granulomatosis with polyangiitis (GPA) is a chronic multisystemic disorder of unknown etiology that leads to necrotising granulomatous vasculitis, commonly involving the respiratory system and the kidneys. Gastrointestinal involvement is a rare manifestation of this disease. Although uncommon, GPA may involve the small bowel or colon and exhibit symptoms of intestinal ischemia and secondary peritonitis, including abdominal pain, fever, diarrhea and gastrointestinal bleeding which are nonspecific. Here we report a case of ischemic bowel disease associated with granulomatosis with polyangiitis to improve the awareness by clinicians.
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van Weelden M, Viola GR, Kozu KT, Aikawa NE, Ivo CM, Silva CA. [Disseminated histoplamosis in adolescent mimicking granulomatosis with polyangiitis]. REVISTA BRASILEIRA DE REUMATOLOGIA 2015; 57:S0482-5004(15)00028-5. [PMID: 25802128 DOI: 10.1016/j.rbr.2015.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 11/06/2014] [Accepted: 01/20/2015] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Systemic histoplasmosis is an invasive fungal infection that may mimic primary vasculitis, particularly granulomatosis with polyangiitis (GPA), and was rarely described in adult patients. We reported an immunocompetent patient with disseminated histoplasmosis mimicking GPA who fulfilled European League Against Rheumatism (EULAR)/Pediatric Rheumatology International Trials Organisation (PRINTO)/Pediatric Rheumatology European Society (PRES) validated classification criteria. CASE REPORT A 6-year old boy presented acute migratory polyarthritis with spontaneous improvement, sinus inflammation, fever, headache and abdominal pain. Serologic test for hepatitis, cytomegalovirus, human immunodeficiency virus, Epstein-Barr virus, toxoplasmosis, dengue virus and antistreptolysin O were all negative. Magnetic resonance imaging (MRI) showed moderate ascites in pelvis and pansinusitis. Antineutrophil cytoplasmic antibodies (c-ANCA) were positive. He had spontaneous remission of the symptoms including fever. At the age of 11 years and 11 months, he had sinusitis, pneumonia and epididymitis. A month later, he was hospitalized and MRI showed left eye proptosis. Cerebrospinal fluid was normal and indirect tests of fungi were negative. Two months later, he had lumbar pain and computer tomography showed a mass in the right kidney and pulmonary nodule in the right lung. He fulfilled EULAR/PRINTO/PRES criteria for GPA, however the renal biopsy showed a focal granulomatous interstitial nephritis with yeast fungal cells compatible with Histoplasma sp. He was treated with liposomal amphotericin B and itraconazole with improvement of signs and symptoms. CONCLUSION We reported a progressive disseminated histoplasmosis case mimicking GPA. Histoplasmosis infection should be considered in immunocompetent subjects with uncommon clinical manifestations, such as arthritis, nephritis and epididymitis.
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Imbalzano E, Lo Gullo A, Costantino R, Tomasello C, Giugno V, Saitta A. Coronary vasculitis in granulomatosis with polyangiitis. Int J Cardiol 2014; 173:593-5. [PMID: 24698240 DOI: 10.1016/j.ijcard.2014.03.099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 03/14/2014] [Indexed: 11/30/2022]
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Jung SM, Jung YH, Noh HJ, Woo IS, Han CW. A case of Wegener's granulomatosis mimicking recurrent hemophagocytic lymphohistiocytosis. Korean J Intern Med 2014; 29:393-7. [PMID: 24851077 PMCID: PMC4028532 DOI: 10.3904/kjim.2014.29.3.393] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 05/08/2013] [Accepted: 08/19/2013] [Indexed: 11/27/2022] Open
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Qian SY, Malata CM. Avoiding pitfalls in open augmentation rhinoplasty with autologous L-shaped costal cartilage strut grafts for saddle nose collapse due to autoimmune disease: the Cambridge experience. J Plast Reconstr Aesthet Surg 2014; 67:e195-203. [PMID: 24742691 DOI: 10.1016/j.bjps.2014.03.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 03/24/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Saddle nose deformity due to autoimmune diseases such as Wegener's Granulomatosis and Relapsing Polychondritis is aesthetically, functionally and psychologically distressing for patients. However, "reliable" options for surgical correction remain limited in the literature. We present our experience of augmentation rhinoplasty in this patient population focussing on the techniques and pitfalls of L-shaped costal cartilage grafting. METHODS Five patients undergoing rhinoplasty for saddle nose deformity due to an autoimmune condition were identified over an 11-year period at a major tertiary centre. All patients were in remission from their condition at surgery and underwent L-shaped costal cartilage grafting at augmentation rhinoplasty. Case notes were reviewed retrospectively. RESULTS All patients achieved a marked improvement in nasal position, shape and contour and were very pleased with their overall appearance. The average length of follow up was 2.8 years. There were no infections, graft exposure or warping. No resorption of cartilage was observed and there have been no recurrent deformities. CONCLUSION This case series describes a possible approach to corrective rhinoplasty in patients with saddle nose deformity caused by autoimmune disease, highlighting the key technical steps and potential pitfalls of intraoperative and perioperative care in this population. The approach is straightforward, reproducible, and achieved pleasing aesthetic outcomes and high patient satisfaction. Given careful planning and meticulous execution, L-strut cartilage grafts for augmentation rhinoplasty to correct saddle nose deformity in these patients is of great benefit. LEVEL OF EVIDENCE Therapeutic Study Level IV, case series with pre/post test.
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Uppal P, Taitz J, Wainstein B, Soma M, Belessis Y, Gray P. Refractory otitis media: an unusual presentation of childhood granulomatosis with polyangiitis. Pediatr Pulmonol 2014; 49:E21-4. [PMID: 23359478 DOI: 10.1002/ppul.22746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 11/15/2012] [Indexed: 11/08/2022]
Abstract
Childhood granulomatosis with polyangiitis (cGPA), previously known as Wegener's granulomatosis, is a rare, potentially fatal necrotizing vasculitis, the symptoms of which overlap with infection. We present a 16-year-old girl who, following 6 months of treatment for persistent middle ear effusion with progressive sensorineural hearing loss, developed rapidly progressing pneumonia, with pleural effusion, and multiple cavitatory lung lesions. Investigations demonstrated high titer c-ANCA and nasal septal biopsy confirmed the diagnosis of cGPA. This case highlights the difficulty in diagnosing cGPA and the potentially life-threatening consequences of failing to do so.
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Pereira Beceiro J, Rodríguez Alonso A, Bonelli Martín C, Pérez Valcárcel J, Mosquera Seoane T, Cuerpo Pérez MÁ. Prostatitis and acute urinary retention as first manifestations of Wegnener's granulomatosis. REUMATOLOGIA CLINICA 2014; 10:409-12. [PMID: 24555967 DOI: 10.1016/j.reuma.2013.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Revised: 08/01/2013] [Accepted: 08/28/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We present a case of prostatitis with acute urinary retention as a rare initial manifestation of Wegener' Granulomatosis. METHODS The case was a 48-year-old male with symptoms of prostatitis over ten days. The patient presented urinary retention, with partial response to antibiotic treatment. High levels of cytoplasmic antineutrophil cytoplasmic antibody and a prostatic biopsy were compatible with Wegener' Granulomatosis. RESULTS After starting treatment with glucocorticoids and cyclophosphamide, a significant improvement to the point of disappearance of symptoms was observed. At 3 months pulmonary and upper airway symptoms began, requiring higher doses of cyclophosphamide to control symptoms. CONCLUSIONS Wegener's Granulomatosis is a multisystem entity whose presentation as prostatitis with urinary retention is rare.
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Armengot M, García-Lliberós A, Gómez MJ, Navarro A, Martorell A. Sinonasal involvement in systemic vasculitides and cocaine-induced midline destructive lesions: Diagnostic controversies. ALLERGY & RHINOLOGY 2013; 4:e94-9. [PMID: 24124643 PMCID: PMC3793120 DOI: 10.2500/ar.2013.4.0051] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Multiple systemic diseases produce various clinical manifestations in the sinonasal area. They usually appear as difficult-to-diagnose disease processes with slow, atypical clinical courses. The aim of this study was to evaluate the sinonasal manifestations of systemic vasculitides, highlighting key points for diagnosis and differential diagnosis with other pathological entities, especially cocaine-induced midline destructive lesions (CIMDL). A retrospective study was performed of 10 patients treated in our hospital during the last 5 years with an initial diagnosis of systemic vasculitides with sinonasal involvement: eight patients with granulomatosis with polyangiitis (GPA; new nomenclature for Wegener granulomatosis) and two patients with Churg-Strauss syndrome (CSS). The study variables were clinical presentation, nasal endoscopy results, maxillofacial scan results, nasal biopsy results, erythrocyte sedimentation rate, and autoimmune antibody levels. The definitive diagnosis was GPA in six (60%) patients, CSS in two (20%) patients, and CIMDL in two (20%) patients. Nasal symptoms were similar in all patients, but nasal polyps were present in only one patient with CSS. Systemic manifestations were absent in patients with CIMDL. Likewise, peripheral eosinophilia was observed only in the two patients with CSS. Specific positive biopsy specimens were obtained in six patients (all six patients with GPA, one with CSS, and one with CIMDL). Antineutrophil cytoplasmic antibodies (ANCA) were positive in all patients with GPA (proteinase 3 antigen in five patients and myeloperoxidase in one patient), and perinuclear ANCA was positive in one patient with CIMDL; however, this patient showed an undefined pattern. Finally, the response to treatment was adequate in all patients excluding those with CIMDL. GPA and CIMDL syndromes pose a difficult differential diagnosis because they have common clinical, serological, and histological presentations. Negative histological results do not exclude the diagnosis of sinonasal vasculitides. The absence of systemic manifestations and the lack of response to treatment will lead to the confirmation of CIMDL syndrome in a cocaine user. Otolaryngologists play an important role in the early and differential diagnosis of these diseases.
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Gupta V, Sharma AK, Sureka RK, Bhuyan SK, Singh PK. Chronic meningitis with multiple cranial neuropathies: A rare initial presentation of Wegener's granulomatosis. Ann Indian Acad Neurol 2013; 16:411-3. [PMID: 24101832 PMCID: PMC3788296 DOI: 10.4103/0972-2327.116920] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 04/29/2012] [Accepted: 08/05/2012] [Indexed: 11/12/2022] Open
Abstract
Wegener's granulomatosis (WG) is a systemic necrotizing vasculitis that affects the small blood vessels. It mainly affects the upper and lower respiratory tract and kidneys. Central nervous system (CNS) involvement is rare, and has been reported only in about 8% of cases during the course of illness. Initial presentation with neurologic affection, particularly chronic hypertrophic meningitis is very unusual. We report the case of a 34 year old male who presented with chronic hypertrophic meningitis and multiple cranial nerve involvement as the initial manifestation, without respiratory and renal symptoms. This case highlights the difficulties in diagnosing a rare disease with rarer presentation, and at the same time illustrates that Wegener's granulomatosis should be considered in the differential diagnosis of chronic meningitis.
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Mahler M, Bogdanos DP, Pavlidis P, Fritzler MJ, Csernok E, Damoiseaux J, Bentow C, Shums Z, Forbes A, Norman GL. PR3-ANCA: a promising biomarker for ulcerative colitis with extensive disease. Clin Chim Acta 2013; 424:267-73. [PMID: 23806819 DOI: 10.1016/j.cca.2013.06.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 06/01/2013] [Accepted: 06/07/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND We determined if PR3-ANCA is a biomarker that differentiates ulcerative colitis (UC) from Crohn's disease (CrD). METHODS A total of 946 sera were tested, including 86 granulomatosis with polyangiitis (GPA) and 491 inflammatory bowel disease (IBD) patients (283 UC and 208 CrD), 264 pathological controls (various diseases) and 105 healthy individuals. All samples were tested for PR3-ANCA by ELISA (QUANTA Flash Lite®, INOVA Diagnostics) and chemiluminescent immunoassays (CIA QUANTA Flash PR3). Conventional anti-neutrophil cytoplasmic antibody (ANCA) indirect immunofluorescence assays (IIF) was performed with NOVA Lite™ (INOVA Diagnostics). RESULTS PR3-ANCA by CIA were detected in 31.1% UC vs. 1.9% CrD sera (p=2.2E-16), and by ELISA in 6% UC and 0% CrD (p=0.0003). In GPA patients, PR3-ANCA were detected in 75.6% by CIA and 61.6% by ELISA (p<0.05). PR3-ANCA by CIA were more prevalent in E3-UC compared to E1/2-UC (p<0.05), and in patients with shorter disease duration (p<0.0001). PR3-ANCA showed similar sensitivity, but significantly higher specificity (p<0.05), compared to atypical pANCA by IIF. CONCLUSION The novel PR3 CIA may prove helpful in the differentiation of CrD from UC, as well as in the identification of UC patients with more extensive disease.
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Valero-Roldán J, Nuñez-Castillo D, Fernández-Fígares C, López-Leiva I. [Massive alveolar haemorrhage in Wegener's granulomatosis]. Semergen 2013; 40:e81-5. [PMID: 23746707 DOI: 10.1016/j.semerg.2013.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 03/11/2013] [Accepted: 03/14/2013] [Indexed: 11/25/2022]
Abstract
Wegener's granulomatosis is a systemic vasculitis with involvement of primary granulomatous upper and lower respiratory tract, glomerulonephritis and vasculitis of small vessels. The lung disease ranges from asymptomatic pulmonary nodules to pulmonary infiltrates and fulminant alveolar haemorrhage. The prognosis is poor due to kidney and respiratory failure, although the data are changing due to new treatments with glucocorticoids and cyclophosphamide. We report a case with severe lung disease, which after appropriate anamnesis, multiple tests, and optimal sequential action, the patient was diagnosed with Wegener's granulomatosis. This disease has a low incidence in the Emergency Department, where the patient history supported by the appropriate additional provides a diagnostic suspicion. It is important that the Emergency Department has the skills to manage the stability in these patients in order to resolve their symptoms.
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Kalra S, Yadav A, Agarwal S, Kumar S. Wegener's granulomatosis with subdural hematoma as the initial manifestation. Int J Crit Illn Inj Sci 2013; 3:88-90. [PMID: 23724392 PMCID: PMC3665127 DOI: 10.4103/2229-5151.109430] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Wegener's granulomatosis (WG) is a systemic vasculitis, which can involve any organ system in the body; however, involvement of central nervous system at presentation is very uncommon. Dural involvement in WG has been infrequently reported; however, presentation with subdural hematoma as the initial manifestation is extremely rare. We present a case of WG presenting as subdural hematoma, which resolved on cytotoxic therapy without surgical evacuation.
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Intense FDG uptake on PET/CT in the upper and lower respiratory system indicative of Wegener's granulomatosis. Rev Esp Med Nucl Imagen Mol 2013; 33:32-5. [PMID: 23680478 DOI: 10.1016/j.remn.2013.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 02/28/2013] [Accepted: 03/01/2013] [Indexed: 11/24/2022]
Abstract
Wegener's granulomatosis (WG) is an uncommon systemic vasculitis, which involves the upper and lower respiratory tracts and the kidneys. Because the patients generally present with clinical manifestations that are similar to common diseases, WG may be initially misdiagnosed as infection or malignancy. We report the case of a 55-year-old male presenting with weight loss, cough, hemoptysis, low-grade fever, and pulmonary nodules detected on the thoracic CT scan. Malignancy was initially suspected, so a PET/CT was performed. It demonstrated intense FDG uptake in the upper and lower respiratory system. The diagnosis of WG was based on PET findings, elevated serum levels of inflammatory markers, and the presence of c-ANCA. We consider that the knowledge of FDG-PET/CT findings may help to make an easier and earlier diagnosis of WG.
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