Related Experiment Video

Updated: Nov 7, 2025

An Immunohistopathologic Study to Profile the Folate Receptor Beta Macrophage and Vascular Immune Microenvironment in Giant Cell Arteritis
06:35

An Immunohistopathologic Study to Profile the Folate Receptor Beta Macrophage and Vascular Immune Microenvironment in Giant Cell Arteritis

Published on: February 8, 2019

7.4K

Challenges in diagnosis of limited granulomatosis with polyangiitis

Olena Zimba1, Bohdana Doskaliuk2, Roman Yatsyshyn3

  • 1Department of Internal Medicine #2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.

Rheumatology International
|May 3, 2021
PubMed

Insights

Granulomatosis with polyangiitis (GPA) can present atypically, leading to delayed diagnosis. Histological examination is crucial for accurate diagnosis, especially when ANCA is negative.

Area of Science:

  • Rheumatology
  • Pathology

Background:

  • Granulomatosis with polyangiitis (GPA) is a rare autoimmune disease often presenting with diverse clinical manifestations.
  • Delayed diagnosis of GPA can lead to severe complications and irreversible organ damage.

Observation:

  • A 71-year-old female experienced a 40-year diagnostic delay for GPA, presenting with atypical nasal symptoms and facial defects.
  • Laboratory tests were inconclusive, with negative anti-neutrophil cytoplasmic antibodies (ANCA) but elevated rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA).
  • Histological analysis revealed granulomas and lymphocytic infiltration, not definitive vasculitis, complicating the initial diagnosis.

Findings:

  • The case highlights a limited form of GPA with atypical serological and histological findings.
  • Despite negative ANCA, granuloma formation was a key diagnostic indicator.

Implications:

  • Emphasizes the critical need for increased clinician awareness of atypical GPA presentations.
  • Underscores the importance of histological examination in the differential diagnosis of GPA, particularly in challenging cases.
  • Suggests that a high index of suspicion and thorough pathological evaluation are vital for timely GPA diagnosis and treatment.
Keywords:
BiopsyDiagnostic errorsDifferential diagnosisGranulomatosis with polyangiitis

More Related Videos

Analyses of Proteinuria, Renal Infiltration of Leukocytes, and Renal Deposition of Proteins in Lupus-prone MRL/lpr Mice09:43

Analyses of Proteinuria, Renal Infiltration of Leukocytes, and Renal Deposition of Proteins in Lupus-prone MRL/lpr Mice

Published on: June 8, 2022

3.2K
Supervised Machine Learning for Semi-Quantification of Extracellular DNA in Glomerulonephritis09:16

Supervised Machine Learning for Semi-Quantification of Extracellular DNA in Glomerulonephritis

Published on: June 18, 2020

7.0K

Related Concept Videos

Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation01:21

Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation

Clinical manifestationsPeripheral Arterial Disease (PAD) manifests through a range of symptoms, from the characteristic intermittent claudication to atypical presentations and severe complications in advanced stages. Intermittent claudication, a hallmark symptom of PAD, presents as exercise-induced muscle pain that typically resolves within minutes of rest. This pain is reproducible and stems from inadequate blood flow, leading to the accumulation of lactic acid produced during anaerobic...
117
Myasthenia Gravis: Diagnostic Tests01:15

Myasthenia Gravis: Diagnostic Tests

Myasthenia gravis is an autoimmune condition affecting neuromuscular transmission, causing generalized weakness in skeletal muscles. Initial diagnoses rely on patients' signs, symptoms, and medical history. The challenge lies in distinguishing myasthenia from other muscular dystrophies. An important diagnostic feature is the significant improvement of symptoms after administering anticholinesterase inhibitors.
The edrophonium test is a diagnostic tool for myasthenia gravis. It involves...
1.6K
Acute Pyelonephritis II: Diagnostic Studies and Management01:28

Acute Pyelonephritis II: Diagnostic Studies and Management

Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
100
Pulmonary Tuberculosis IV01:26

Pulmonary Tuberculosis IV

Tuberculosis, more commonly referred to as TB, is an infectious disease stemming from Mycobacterium tuberculosis. While it primarily impacts the lungs, TB can also affect other body areas. Given its severity and global impact, timely and accurate diagnosis is crucial for controlling its spread and improving patient outcomes.
Several diagnostic approaches are used to detect TB. The conventional method is the Tuberculin Skin Test (TST), also known as the Mantoux test. However, this method has...
255
Nephrotic Syndrome II : Assessment and Medical Management01:26

Nephrotic Syndrome II : Assessment and Medical Management

IntroductionNephrotic syndrome is a kidney disorder marked by excessive protein loss in the urine, leading to various systemic complications. This condition often results from damage to the glomeruli—the kidney's filtering units—causing proteinuria, low blood protein levels, and fluid retention. Understanding the assessment, diagnosis, and management of nephrotic syndrome is essential for effective treatment and prevention of further kidney damage.AssessmentPatient History: Document...
52