Relapsing granulomatosis with polyangiitis provoked by trauma: A case report.

Abstract:

RATIONALE:The precise cause of granulomatosis with polyangiitis (GPA) remains unclear. Herein we present a case of refractory GPA occurring after trauma. PATIENT CONCERNS:A 43-year-old man suffered fractures of the left orbital in an accident, and then received surgical repair. At a postoperative follow-up, he developed maxillary sinusitis. Seven months later, he was hospitalized with symptoms of cough, high-grade fever, and loss of weight. DIAGNOSIS:He was diagnosed with GPA based on the symptoms of upper and lower respiratory tract involvement, granulomas in a lung biopsy specimen, and presence of PR3-ANCA. INTERVENTIONS:Initially the patient responded well to the treatment of glucocorticoids and cyclophosphamide (CYC). Forty days later, he was hospitalized again with symptoms of fever, cephalgia, and recurrent ulcerated subcutaneous nodules, due to the vasculitic manifestations of GPA. This time he was treated with cyclophosphamide and glucocorticoids with no improvement, and then switched to rituximab. OUTCOMES:After 4 doses of rituximab, the symptom of cephalgia disappeared and subcutaneous ulcerations and conjunctival congestion diminished. LESSONS:Trauma may act as an inflammatory stimulus to affect the course of disease in GPA. The combination of glucocorticoids and cyclophosphamide is the standard therapy for GPA. Nevertheless, patients who have no response to CYC, especially with predominantly vasculitic manifestations, could resort to rituximab.

journal_name

Medicine (Baltimore)

journal_title

Medicine

authors

Deng S,Xing Y,Wang H,Kong X

doi

10.1097/MD.0000000000014189

subject

Has Abstract

pub_date

2019-01-01 00:00:00

pages

e14189

issue

3

eissn

0025-7974

issn

1536-5964

pii

00005792-201901180-00085

journal_volume

98

pub_type

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