Abstract
A 43-year-old lady presenting with longstanding bilateral nasal obstruction, anosmia, bloody crusts and blood-stained nasal discharge. She also had bilateral hearing loss. She tried some topical steroid nasal sprays and saline nasal douches before without much improvement. The patient also gave a history of cough, haemoptysis and dyspnoea, particularly on exertion, as well as haematuria. External nose examination has shown a saddle nose deformity. On examination by anterior rhinoscopy, the nasal mucosa shows multiple areas of ulceration and granulations. On endoscopic examination, the nasal cavity was filled with multiple crusts, and some adhesions between the septum and lateral nasal wall could be seen. Both tympanic membranes were markedly retracted, showing a clinical picture of otitis media with effusion. Endoscopic examination of the larynx has shown subglottic stenosis. C- ANCA was positive. Kidney function tests were elevated. CT scan of nose and sinuses has shown non-specific mucosal thickening and evidence of bone destruction. Renal biopsy has shown granulomatous inflammation with vasculitis and necrosis.
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Bibliography
Yates M, Watts R. ANCA-associated vasculitis. Clin Med (Northfield Il). 2017;17(1):60.
Geoffrey M, Lubitz BS. Granulomatosis with polyangiitis—a moral impetus for change. JAMA Otolaryngol Head Neck Surg. 2018;144(2):101.
White PD, Rickards H, Zeman AZJ. Time to end the distinction between mental and neurological illnesses. BMJ. 2012;344:e3454.
Kuan EC, Suh JD. Systemic and odontogenic etiologies in chronic rhinosinusitis. Otolaryngol Clin N Am. 2017;50(1):95–111.
Pakalniskis MG, Berg AD, Policeni BA, Gentry LR, Sato Y, Moritani T, et al. The many faces of granulomatosis with polyangiitis: a review of the head and neck imaging manifestations. Am J Roentgenol. 2015;205(6):W619–29.
Singer O, McCune WJ. Update on maintenance therapy for granulomatosis with polyangiitis and microscopic polyangiitis. Curr Opin Rheumatol. 2017;29(3):248–53.
Lally L, Spiera R. Current therapies for ANCA-associated vasculitis. Annu Rev Med. 2015;66:227–40.
Bosch X, Guilabert A, Espinosa G, Mirapeix E. Treatment of antineutrophil cytoplasmic antibody-associated vasculitis: a systematic review. JAMA. 2007;298(6):655–69.
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Morsy, M., Stavrakas, M. (2021). Granulomatosis with Polyangitis (GPA). In: Stavrakas, M., Khalil, H.S. (eds) Rhinology and Anterior Skull Base Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-66865-5_61
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DOI: https://doi.org/10.1007/978-3-030-66865-5_61
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