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
Summary
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.
Related Concept Videos
01:25Endocarditis II: Clinical features and Diagnostic Tests
2
Endocarditis can present various clinical features depending on the causative organism and the patient's underlying health conditions. Initially, the clinical features of infective endocarditis develop gradually, presenting with nonspecific symptoms that can be easily mistaken for other illnesses.General SymptomsEarly symptoms of infective endocarditis are fever, chills, weakness, malaise, fatigue, and weight loss. These symptoms reflect the systemic nature of the infection and the body's...
2
01:23Rheumatic Heart Disease I: Introduction
3
Rheumatic heart disease or RHD is a chronic condition that results from rheumatic fever, causing permanent damage to the heart valves.Etiology and Risk FactorsIt primarily arises from rheumatic fever, an inflammatory disease that can develop after untreated or inadequately treated group A streptococcal (GAS) pharyngitis. Streptococcus spreads through direct contact with oral or respiratory secretions. While the bacteria are the causative agents, factors like malnutrition, overcrowding, poor...
3
01:27Myocarditis II: Clinical features and Diagnostic Tests
2
Myocarditis is an inflammation of the heart muscle. The symptoms vary widely, encompassing asymptomatic presentations to severe, acute manifestations.Clinical PresentationAsymptomatic cases: In some instances, myocarditis may be asymptomatic, with the infection resolving without intervention. These cases often go undetected unless discovered incidentally through diagnostic imaging or tests conducted for other reasons.General Early Symptoms: Early symptoms of myocarditis are non-specific and can...
2
01:30Peripheral Artery Disease I: Introduction
2
Peripheral artery disease (PAD) predominantly results from atherosclerosis, which involves the accumulation of fatty deposits, or plaques, within the walls of arteries. This causes them to narrow and harden, significantly reducing blood flow. PAD predominantly affects the legs but also impacts other areas, such as the arms, thereby impairing overall circulation and organ function.Etiology of PAD:The principal cause of PAD is atherosclerosis, which results from fatty deposits inside the arterial...
2
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
2
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...
2