title: Fulminant Wegener's granulomatosis presenting as epistaxis.
abstract: The case of a 63-year-old woman who presented to the emergency department with epistaxis and haemodynamic instability is reported. Subsequent investigation showed renal failure and multiple pulmonary nodules. A positive proteinase 3 antineutrophil cytoplasmic antibody test supported the diagnosis of fulminant Wegener's granulomatosis, requiring urgent dialysis, plasma exchange and immunosuppression. This is the first report in the emergency literature of Wegener's granulomatosis presenting as acute epistaxis. Emergency physicians should consider Wegener's granulomatosis in patients with atypical epistaxis. In patients presenting with clinically severe, active disease early proteinase 3 antineutrophil cytoplasmic antibody testing is recommended.
authors.affiliation: Department of Otorhinolaryngology, Peterborough & Stamford NHS Trust, Peterborough, UK. ankurthapar@doctors.org.uk
authors.forename: Ankur
authors.initials: A
authors.lastname: Thapar
authors.forename: Ajith
authors.initials: A
authors.lastname: George
authors.forename: Andrew
authors.initials: A
authors.lastname: Pfleiderer
mesh_terms: D001323:Autoantibodies / Q000032:analysis; D015415:Biomarkers / Q000032:analysis; D004844:Epistaxis / Q000209:etiology*; D005260:Female; D014890:Granulomatosis with Polyangiitis / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology; D008171:Lung Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D008875:Middle Aged; D053146:Myeloblastin / Q000276:immunology; D014057:Tomography, X-Ray Computed
chemical_list: D001323:Autoantibodies; D015415:Biomarkers; D053146:Myeloblastin