[Chronic bilateral necrotizing and destructive granulomatous inflammatory process in the region of the paranasal sinuses and the orbita as manifestation of localized Wegener's granulomatosis].
METHODS
Granulomatous infectious processes have a wide differential diagnosis. This report describes the case of a 73-year-old woman who had gone through an 8-year ordeal involving several paranasal sinus operations, development of chronic facial pain, orbital exenteration of the left eye, and now threatening loss of the remaining right eye on account of progression of the chronic inflammation. Despite repeated histologic examination of ENT material by various pathologic institutes, neither the histology nor laboratory parameters were able to point us in the right direction. In the end, it was the clinical course which led to the diagnosis of Wegener's granulomatosis.


CONCLUSIONS
In chronic necrotizing granulomatous inflammatory processes in the region of the paranasal sinuses with involvement of the surrounding anatomic structures (orbit, skull base), Wegener's granulomatosis should be included in the differential diagnosis at an early stage, even if the typical signs of vasculitis and the typical antibodies are absent. The clinical course calls for an interdisciplinary treatment approach in conjunction with internists experienced in immunosuppressant therapy.
Keerl
Rainer
R
Klinik für HNO-Heilkunde, Kopf- Hals- und Plastische Gesichtschirurgie, Klinikum Straubing. KeerlR@klinikum-straubing.de
Löhr
Dirk
D
Kahle
Gabriele
G
Kronsbein
Hartmut
H
Fassbinder
Winfried
W
Draf
Wolfgang
W
D000368:Aged; D003937:Diagnosis, Differential; D018450:Disease Progression; D005260:Female; D014890:Granulomatosis with Polyangiitis / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D009915:Orbit / Q000473:pathology / Q000601:surgery; D010254:Paranasal Sinus Diseases / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D010256:Paranasal Sinuses / Q000473:pathology / Q000601:surgery; D012008:Recurrence