Case Report: Wegener Granulomatosis in Differential Diagnosis of Chronic Rhinosinusitis
Introduction: Wegener granulomatosis (WG) is a specific disorder characterized by necrotizing granulomatous vasculitis, intravascular or extravascular of the upper and lower respiratory tracts, associated with glomerulonephritis. A case of WG serviced at the Otorhinolaryngology of Hospital das Forças Armadas (HFA), DF, Brazil, is reported.
Case Report: A 77-year-old female patient presented in July 2013 with epistaxis, facial pain, postnasal drip, and daily fever was diagnosed and treated with acute rhinosinusitis (azithromycin, quinolone, ceftriaxone, and clindamycin). She was admitted in the HFA on May 9, 2013, and was medicated with piperacillin + tazobactam and caspofungin on September 6, 2013, as well as maxillary antrostomy and ethmoidectomy rights as computed tomography (CT). After drainage, meropenem and fluconazole medication started. No improvement of the general condition and fever was observed. Vancomycin was introduced to the patient. The patient experienced worsening of renal function.
Results: The result for ANCA (antineutrophil cytoplasmic antibody testing) was positive, cultures were negative, and the chest CT was normal. Renal biopsy was performed and pulse therapy was initiated using methylprednisolone, followed by prednisone 1 mg/kg, with significant improvement. The hospital discharged the patient from using cyclophosphamide, prophylactic Bactrim, and prednisone. WG is a rare disease (prevalence at 3:100,000) affecting mostly white and has equivalent ratio (1 ♀: 1 ♂). Diagnosis by tissue biopsy was by necrotizing granulomatous vasculitis. About 90% of patients with active WG, ANCA antiproteinase-3 were positive.
Conclusion: About 95% of patients with WG have lesions in the paranasal sinuses and nasopharynx, with pain and rhinorrhea with pus and sometimes ulceration of the mucosa, making it important in the differential diagnosis of chronic rhinosinusitis.
Keywords: Granulomatosis, rhinosinusitis, wegener.