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Epistaxis due to Wegener's granulomatosis in a pediatric patient
Don Hayes1, Joseph A Iocono, Jeffery S Bennett
1Department of Pediatrics, University of Kentucky College of Medicine, J410 Kentucky Clinic, Lexington, KY 40536, USA. don.hayes@uky.edu
Insights
Recurrent epistaxis in an adolescent, often benign, was caused by rare Wegener's granulomatosis. Early diagnosis of this childhood vasculitis is crucial for effective treatment.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Rheumatology
- Pediatric Nephrology
Background:
- Epistaxis is a common pediatric condition, usually self-limiting and rarely requiring hospitalization.
- Childhood vasculitides are uncommon, often presenting with characteristic imaging findings and clinical syndromes.
- Kiesselbach's plexus is a frequent source of anterior nosebleeds in children.
Observation:
- A case of an adolescent experiencing persistent epistaxis for over three months is presented.
- The recurrent nosebleeds were initially misdiagnosed as a benign hemorrhage from Kiesselbach's plexus.
- The underlying cause was identified as Wegener's granulomatosis, a rare childhood vasculitis.
Findings:
- Wegener's granulomatosis can manifest as recurrent epistaxis in adolescents.
- Misdiagnosis of epistaxis can delay the identification of rare underlying systemic diseases.
- Systemic vasculitis should be considered in cases of persistent or severe epistaxis, especially when refractory to standard treatment.
Implications:
- Highlights the importance of considering systemic vasculitis in the differential diagnosis of recurrent epistaxis in children.
- Emphasizes the need for thorough investigation in cases of persistent epistaxis unresponsive to typical management.
- Underscores the potential for rare conditions like Wegener's granulomatosis to present with seemingly common symptoms.
Abstract:
Epistaxis is a common problem in children that typically is not severe and seldom requires hospitalization. The nose is a highly vascular structure with a large surface area; subsequently, it is highly predisposed to bleeding. Childhood vasculitides are very rare and are commonly diagnosed by characteristic lesions on imaging studies along with syndrome recognition by clinicians. We present a case of recurrent epistaxis that persisted over 3 months due to Wegener's granulomatosis in an adolescent that was misdiagnosed as a benign hemorrhage from Kiesselbach's plexus.
