Multiple abscesses of the head and neck as a first manifestation of granulomatosis with polyangiitis

Granulomatosis with polyangiitis (GPA) is a manifestation of vasculitis of small and medium vessels accompanied by necrotizing granulomas. Most commonly affected organs are the upper airways and the kidneys. Clinical course of the disease can vary from local sinonasal to early systemic affections. A 24 years-old homeless patient was referred to hospital with a sepsis due to multiple abscesses of the orbit and parotid gland. A CT-scan revealed pulmonary infiltrates and an opacification of the paranasal sinuses. During clinical course, polyuria and polydipsia as well as hyponatraemia and hypoglycaemia were noticed. The abscesses were drained immediately and an antibiotic treatment was initiated. The water-electrolyte imbalance was caused by a panhypopituitarism. An MRI of the head yielded a pituitary abscess, which was drained transsphenoidally. Intraoperative microbiological tests as well as blood cultures were negative. Furthermore, HIV tests and TB-ELISpot were negative. No abnormalities were found in echocardiography. Histopathological examination revealed phlegmonous inflamed tissue without suspicion of malignancy. Finally, serological detection of PR3-cANCA could confirm the suspected diagnosis of GPA. Abscesses of the head and neck region or the pituitary gland are a rare manifestation of GPA. In this case, clinical findings indicated a septic manifestation. However, microbiology was negative. Even if no granulomas can be detected histopathologically, GPA should be considered as a differential diagnosis to allow for an immediate immunosuppressive therapy.

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Der Erstautor gibt keinen Interessenskonflikt an.

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Artikel online veröffentlicht:
13. Mai 2021