[Vasculitis: New nomenclature of the Chapel Hill consensus conference 2012]

Granulomatosis with polyangiitis: Possible endocrine manifestations

Granulomatosis with polyangiitis (GPA), formerly known as Wegener's granulomatosis, is a necrotizing vasculitis of small and medium-sized blood vessels characterized by diffuse inflammation of vascular structures and perivascular and extravascular granulomatosis. In its systemic form, GPA predominantly affects the ear, nose and throat, with lung and kidney involvement with typically rapidly progressive necrotizing glomerulonephritis with extracapillary crescents, while the absence of kidney damage at the time of diagnosis is defined as a limited form of GPA with a more favorable prognosis (1, 2). Antineutrophil cytoplasmic antibodies (c-ANCA) with specificity for proteinase 3 (PR3) represent a biochemical diagnostic criterion. They are detected in 90% of generalized forms and in about 50% of limited forms of granulomatosis with polyangiitis (1, 2). In the absence of treatment, GPA is a disease of progressive evolution. Systemic corticosteroid therapy and immunosuppressive therapy significantly changed the prognostic aspect of the disease. Only a few sporadic observations have been published on endocrine disorders associated with GPA. We present a case of a man, 39 years old, with Wegener's granulomatosis who developed autoimmune thyroiditis 8 years after the initial diagnosis.

Behcet's disease presenting with primary hypothyroidism, adrenal insufficiency, and celiac disease: A case report

We are reporting a case report of Behcet's disease with autoimmune dysfunction that affected the thyroid and adrenal glands and the patient also had sub-clinical celiac disease. However, the correlation between Bechet's disease and autoimmune disease is still controversial.

Granulomatosis with polyangiitis (Wegener's granulomatosis): a rare variant of sudden natural death

Granulomatosis with polyangiitis (GPA), formerly known as Wegener's granulomatosis, is the most common form of life-threatening small-vessel vasculitis. Although its exact pathogenesis remains unclear, GPA is believed to belong to the wide complex of autoimmune diseases due to the presence of anti-neutrophil cytoplasmatic antibodies with cytoplasmic staining pattern (c-ANCA) that is expressed in activated neutrophils. GPA predominantly manifests at the upper and lower respiratory tract and the kidneys, but the impairment of multiple organ systems is possible as well. The so-called classical clinical triad of GPA comprises sinusitis, pneumonia, and glomerulonephritis. Despite the fact that there is an elevated risk of mortality for patients suffering from GPA, sudden death due to GPA is a rare and difficult differential diagnosis of sudden natural death in forensic case work. In the present article, the rare case of a 41-year-old male, who died of a sudden death due to previously undiagnosed GPA, is demonstrated. The final diagnosis was feasible by close interdisciplinary collaboration, considering the entire body of findings obtained during autopsy, histopathological investigation, and analysis of the clinical records. Therefore, it remains necessary to point out that especially for rare causes of death, interdisciplinary collaboration is essential in order to concretize the cause of death and exclude rare differential diagnoses of sudden unexpected death of hospitalized patients in forensic case work.

[Clinical pathology of granulomatous inflammation : With special emphasis on the lungs and central nervous system]

CLINICAL ISSUE

Granulomatous diseases are not rare in routine daily diagnostics. Granulomas are an indication of a sufficiently functioning immune system. In the absence of granulomas, a possible immunodeficiency should also be considered (e.g. in tuberculosis) in the diagnostic procedure. Many types of diseases with different etiologies can cause granulomatous manifestations.

DIAGNOSTICS

Diagnostic procedures should be oriented to the clinical symptoms and should include blood analyses, radiography, especially computed tomography (CT) and magnetic resonance imaging (MRI) and sampling for histology or cytology. In the case of proven granulomatous inflammation an infectious etiology should first be excluded. The diagnosis of a granulomatous disease should always be confirmed by histopathology when possible.

ACHIEVEMENTS

In this study the origins and general histopathological classification of granulomatous diseases are presented. In addition to the most common granulomatous diseases, some special and rare forms are discussed, which should also be considered in the differential diagnostic process.

PRACTICAL RECOMMENDATIONS

The diagnosis of a granulomatous disease should always be made in an interdisciplinary cooperation and requires close collaboration between radiologists, internists, pathologists and specialists in laboratory parameters.