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A destructive centrofacial granuloma: Case report
Zineb Tazi Saoud1, Fatima Zahra Elfatoiki1, Soumiya Chiheb1
1Department of Dermatology and Venerology, Ibn Rochd University Hospital, Casablanca, Morocco.
Annals of Medicine and Surgery (2012)
|February 24, 2022
Summary
Granulomatosis with polyangiitis (GPA) can present as localized facial granulomas, causing significant destruction. Early diagnosis through deep biopsies is crucial to prevent disfigurement.
Area of Science:
- Dermatology
- Rheumatology
- Pathology
Background:
- Centrofacial granulomas present diagnostic challenges due to diverse etiologies.
- Granulomatosis with polyangiitis (GPA) can manifest in localized forms, complicating diagnosis and management.
Observation:
- A 76-year-old man developed a 3-year evolving pruritic centrofacial plaque with destructive nasal changes.
- Initial skin biopsies and immunological assessments were inconclusive.
- Surgical biopsy revealed non-necrotizing granulomatous inflammation with vasculitis, leading to a diagnosis of GPA.
Findings:
- Localized GPA constitutes up to 29% of cases, with varying ANCA positivity (50-78%) compared to diffuse forms (>90%).
- This case represents a rare subset of GPA affecting the face and upper airways, causing significant cartilage and bone destruction.
- Treatment with prednisone and cyclophosphamide was initiated, with no systemic involvement detected during follow-up.
Implications:
- Evoking localized GPA is essential for any facial granulomatosis presentation.
- Multiple deep biopsies are recommended for accurate diagnosis.
- Early diagnosis and treatment are critical to prevent mutilating sequelae of GPA.
