title: A case of exorbitism in association with Wegener's granulomatosis with renal involvement.
abstract: Wegener's granulomatosis (WG) is a necrotizing granulomatous vasculitis involving the nose, paranasal sinuses, lungs, and kidneys. Ocular involvement can occur in about 50% of cases. There are very few reports of WG with orbital inflammation and exorbitism. We report a case of a female patient who presented with exorbitism related to orbital inflammation secondary to WG, with renal involvement. A 29-year-old woman with a previous history of recurrent pan-sinusitis presented with bilateral exophthalmos and renal failure with rapidly progressive glomerulonephritis. Computed tomography showed extensive bilateral soft tissue in the retro-orbital area. Immunologic tests showed the presence of type-C anti-neutrophil cytoplasmic antibodies and renal biopsy revealed pauci immune crescentic glomerulonephritis. The patient was treated with corticosteroids and pulses of cyclophosphamide followed by azathioprine and trimethoprim-sulfamethoxazole. After a follow-up of 10 months, the renal outcome was favorable with improvement of renal function but there was persistence of exorbitism and loss of visual function. Our case suggests that WG should be considered in the differential diagnosis of persistent bilateral exophthalmos. Prompt recognition of this early manifestation is important for the institution of early treatment.
authors.affiliation: Department of Nephrology, La Rabta Hospital, Tunis, Tunisia. soumaya.beji@rns.tn
authors.forename: S
authors.initials: S
authors.lastname: Beji
authors.forename: L Ben
authors.initials: LB
authors.lastname: Fatma
authors.forename: A
authors.initials: A
authors.lastname: Chebbi
authors.forename: L
authors.initials: L
authors.lastname: Rais
authors.forename: M
authors.initials: M
authors.lastname: Krid
authors.forename: W
authors.initials: W
authors.lastname: Smaoui
authors.forename: H Ben
authors.initials: HB
authors.lastname: Maiz
authors.forename: K
authors.initials: K
authors.lastname: Zouaghi
authors.forename: F Ben
authors.initials: FB
authors.lastname: Moussa
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D005094:Exophthalmos / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D005260:Female; D005921:Glomerulonephritis / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D014890:Granulomatosis with Polyangiitis / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D011859:Radiography; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D000890:Anti-Infective Agents; D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D003520:Cyclophosphamide; D001379:Azathioprine