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Granulomatosis With Polyangiitis Mimicking Temporal Arteritis

Ali Dehghan1, Mahya Sadat Emami Meybodi2, Shokoofeh Fooladmotlagh2

  • 1Division of Rheumatology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

Case Reports in Rheumatology
|October 25, 2024
PubMed

Insights

Granulomatosis with polyangiitis (GPA) can cause pachymeningitis in elderly patients, presenting as daily headaches. Early diagnosis using brain MRI and ANCA testing is crucial for effective treatment and symptom resolution.

Area of Science:

  • Neurology
  • Rheumatology
  • Nephrology

Background:

  • Granulomatosis with polyangiitis (GPA) is a rare autoimmune vasculitis.
  • Pachymeningitis, inflammation of the dura mater, is an uncommon manifestation of GPA.
  • Elderly patients with persistent headaches require thorough investigation for underlying causes.

Observation:

  • An elderly Iranian male presented with persistent daily headaches.
  • Cerebrospinal fluid PCR for infections was negative.
  • Brain MRI revealed a pachymeningitis pattern.

Findings:

  • Diagnosis of GPA was confirmed by positive anti-PR3 antibodies and proteinuria.
  • Treatment involved pulse methylprednisolone, cyclophosphamide, and oral prednisolone.
  • Patient experienced complete resolution of headaches, hearing loss, and vision loss.

Implications:

  • GPA should be considered in the differential diagnosis of pachymeningitis in elderly patients with headaches.
  • Contrast-enhanced brain MRI is a vital diagnostic tool for identifying GPA-related pachymeningitis.
  • Prompt diagnosis and treatment of GPA can lead to significant clinical improvement.
Keywords:
granulomatosis with polyangiitispachymeningitistemporal arteritis

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