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[A 46-year-old-patient with granulomatous prostatitis, arthralgia and haemorrhagic rhinitis]
F Heldmann1, J Brandt, H Schoppe
1Rheumazentrum Ruhrgebiet, St. Josefs-Krankenhaus, 44652 Herne. heldmann@rheumazentrum-ruhrgebiet.de
History And Admission Findings:
A 46-year-old, having developed developed gross haematuria and pain in the genital region, was referred to a urological unit. Because palpation of his prostatic gland was abnormal, a transurethral prostatic resection was performed. The histology showed a necrotizing and granulomatous inflammation of the prostate with small-vessel vasculitis and eosinophilic infiltrates. As the patient had also developed arthralgia and symptoms in the upper respiratory tract, he was admitted to our hospital. The test for c-ANCA with specifity for proteinase 3 was positive. There was no history or symptoms of asthma.
Diagnosis:
Wegener's granulomatosis.
Treatment And Course:
To achieve remission bolus therapy with cyclophosphamide and prednisolone was initiated and planned to be the first of three pulses But when the patient developed epididymitis and a neuropathy associated with Wegener"s granulomatosis, the dose was increased and cyclophosphamide was given for a longer period.
Conclusion:
The early manifestation of Wegener"s granulomatosis at the prostatic gland is rare in this disease. This case presented with an impressive variation of symptoms, which may occur especially in the early course of vasculitis. The findings of c-ANCA with specifity for proteinase 3 is important for the diagnosis of this disease.
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