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Subdural and meaningful involvement related to Wegener's granulomatosis: case report
1Department of Neurological Surgery, Wakayama Medical College, Wakayama City, Japan.
Objective And Importance:
The first case of Wegener's granulomatosis associated with subdural empyema is presented.
Clinical Presentation:
A 37-year-old man was admitted to our hospital for treatment of bilateral subdural masses. Magnetic resonance imaging demonstrated strong bilateral subdural and meningeal enhancement. The patient was treated with subdural drainage, based on the diagnosis of bilateral subdural hematoma or empyema as revealed by magnetic resonance imaging. Even after surgery, he developed systemic symptoms that are typical for Wegener's granulomatosis, including hemosputum, papules, peripheral nervous disorders, hematuria, myalgia, and joint pain. A diagnosis of Wegener's granulomatosis was confirmed by positive circulating antineutrophil cytoplasmic antibodies and histological findings from the skin and nasal mucosa. We diagnosed the subdural masses as Wegener's granulomatosis from the laboratory and neuroimaging studies, retrospectively.
Intervention:
Pus-like fluid containing hematoma with negative micro-organism was evacuated by surgery.
Conclusion:
Wegener's granulomatosis should be suspected in young patients with pulmonary symptoms and subdural hematoma without head injury. This is the first case of Wegener's granulomatosis associated with subdural masses.
Insights
This case study highlights Wegener's granulomatosis (WG) presenting as subdural masses. Early suspicion of WG is crucial in young patients with pulmonary symptoms and unexplained subdural hematomas.
Area of Science:
- Neurology
- Rheumatology
- Infectious Diseases
Background:
- Wegener's granulomatosis (WG) is a rare autoimmune vasculitis.
- Subdural empyema typically results from bacterial or fungal infections.
Observation:
- A 37-year-old male presented with bilateral subdural masses, initially suspected as hematoma or empyema.
- Despite surgical drainage, the patient developed systemic symptoms characteristic of WG, including pulmonary, dermatological, and neurological manifestations.
- Diagnosis was confirmed by positive antineutrophil cytoplasmic antibodies (ANCA) and histological findings.
Findings:
- This is the first reported case of WG presenting as subdural masses.
- Neuroimaging revealed bilateral subdural and meningeal enhancement.
- Laboratory and histological analyses confirmed WG.
Implications:
- Wegener's granulomatosis should be considered in the differential diagnosis of subdural masses, especially in young patients with pulmonary symptoms and no history of head trauma.
- This case expands the known neurological manifestations of WG.
- Highlights the importance of a multidisciplinary approach in diagnosing rare conditions.