Urethral involvement in granulomatosis with polyangiitis: a case-based review

Area of Science:

• Nephrology
• Rheumatology
• Urology

Background:

• Granulomatosis with polyangiitis (GPA) is a systemic vasculitis typically affecting the respiratory tract and kidneys.
• Urinary tract involvement in GPA, particularly urethral manifestation, is exceptionally rare.
• Recurrent urinary tract infections and bladder outlet obstruction can be presenting symptoms.

Observation:

• A case of GPA presenting with acute bladder outlet obstruction due to urethral thickening is described.
• The patient experienced recurrent urinary tract infections, indicative of potential urinary tract involvement.
• Urethral involvement by GPA, though rare, can mimic other urological conditions.

Findings:

• GPA can manifest as urethral inflammation and thickening, leading to significant urinary obstruction.
• The incidence of GPA affecting the urethra may be underestimated.
• This condition affects both males and females, with a higher prevalence in males, and can occur at any age.

Implications:

• Rheumatologists and urologists should consider GPA in the differential diagnosis of unexplained urethral obstruction and recurrent UTIs.
• Prompt diagnosis and treatment of urethral GPA can prevent severe complications.
• While medical management is primary, surgical intervention may be necessary for urethral strictures caused by GPA.