Seronegative granulomatosis with polyangiitis presenting as an acute skull base osteomyelitis with multiple cranial neuropathies
Open Access
- 1 October 2021
- journal article
- research article
- Published by Oxford University Press (OUP) in Journal of Surgical Case Reports
- Vol. 2021 (10), rjab476
- https://doi.org/10.1093/jscr/rjab476
Abstract
Granulomatosis with polyangiitis (GPA, formerly Wegener’s) is a rare form of vasculitis, commonly affecting the upper and lower respiratory tract with simultaneous glomerulonephritis. Ear, nose and throat (ENT) manifestations account for the majority of presentations. The presence of antineutrophil cytoplasmic antibody is a recognized hallmark of GPA, but clinicians should remain cautious of false negative results. We describe a rare case of GPA presenting with concurrent middle ear disease and multiple lower cranial nerve palsies. Clinical judgment was affected by repeated negative autoimmune screens, and a definitive diagnosis was only achieved following renal biopsy. Reported cases of GPA presenting with mastoiditis or cranial nerve involvement are typically seropositive, with seronegative GPA following a less aggressive process. This case highlights the importance of clinical suspicion in the face of treatment resistant ENT pathology, and the need for early histopathological analysis. Early diagnosis and treatment are crucial in limiting disease progression.Keywords
This publication has 4 references indexed in Scilit:
- Head and Neck Manifestations of Granulomatosis with Polyangiitis: A Retrospective analysis of 19 Patients and Review of the LiteratureInternational Archives of Otorhinolaryngology, 2019
- Epidemiology and Outcomes of Granulomatosis With Polyangiitis in Pediatric and Working‐Age Adult Populations In the United StatesArthritis & Rheumatology, 2018
- Two clinical cases of granulomatosis with polyangiitis with isolated otitis media and mastoiditisRheumatology, 2017
- Wegener's granulomatosis presenting with bilateral facial nerve palsyEuropean Archives of Oto-Rhino-Laryngology, 2001