Fulminant Wegener's granulomatosis presenting as epistaxis.
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.
Thapar
Ankur
A
Department of Otorhinolaryngology, Peterborough & Stamford NHS Trust, Peterborough, UK. ankurthapar@doctors.org.uk
George
Ajith
A
Pfleiderer
Andrew
A
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
D001323:Autoantibodies; D015415:Biomarkers; D053146:Myeloblastin