Granulomatosis with polyangiitis: The trigger cannot be long hidden

Area of Science:

• Immunology
• Nephrology
• Rheumatology

Background:

• Granulomatosis with polyangiitis (GPA) is a systemic vasculitis affecting multiple organs, notably the respiratory tract and kidneys.
• Diagnosis typically involves clinical suspicion, elevated antineutrophil cytoplasmic antibodies (ANCA), and organ biopsy confirmation.
• Viral infections are implicated as potential triggers for GPA development.

Purpose of the Study:

• To report a rare case of GPA.
• To investigate the association between cytomegalovirus (CMV) infection and GPA onset.
• To highlight diagnostic considerations in immunocompromised patients.

Main Methods:

• Case report detailing clinical presentation and diagnostic workup.
• Review of patient's medical history for underlying immunocompromised status.
• Serological and biopsy confirmation of GPA and CMV infection.

Main Results:

• The patient presented with clinical features suggestive of GPA.
• Elevated ANCA titers and positive biopsy confirmed GPA.
• Concurrent cytomegalovirus infection was identified in a patient with an undiagnosed immunocompromised state.

Conclusions:

• Cytomegalovirus infection can precipitate GPA in individuals with previously unrecognized immunocompromise.
• This case underscores the importance of considering viral triggers in GPA pathogenesis.
• Early identification of underlying immune deficiencies is crucial for managing GPA.