title: Case of granulomatosis with polyangiitis (Wegener's granulomatosis) manifested with asymptomatic intracerebral hemorrhage.
abstract: A 46-year-old man, who had had sinusitis, developed bilateral omalgia, petechiae on his lower extremities and a congested right eye. A blood test detected elevated serum C-reactive protein level. Computed tomography incidentally found an acute lesion of thalamic hemorrhage without neurological symptoms and no specific therapy was given at the time. Thereafter, he developed vertigo, vomiting and pneumonia for which antibiotics were ineffective. He was referred and admitted to our hospital. Further, aural and renal lesions, and presence of serum proteinase 3-antineutrophil cytoplasmic antibody (PR3-ANCA) confirmed his diagnosis of granulomatosis with polyangiitis (Wegener's) (GPA). With corticosteroid and cyclophosphamide therapy, his symptoms disappeared in two months along with faded PR3-ANCA. Afterward he showed neither new cerebral lesion nor symptom. This is a rare case of GPA manifested with asymptomatic intracerebral hemorrhage. It should be noted that GPA could cause various manifestations in central nervous system such as a fatal or an asymptomatic hemorrhagic lesion, which might respond to immunosuppressive therapy.
authors: Department of Rheumatology, Sagamihara National Hospital, National Hospital Organization.
authors: Hirokazu
authors: H
authors: Takaoka
authors: Atsushi
authors: A
authors: Hashimoto
authors: Shinichi
authors: S
authors: Nogi
authors: Kanako
authors: K
authors: Iwata
authors: Hidekazu
authors: H
authors: Futami
authors: Yoshiyuki
authors: Y
authors: Arinuma
authors: Kota
authors: K
authors: Shimada
authors: Hisanori
authors: H
authors: Nakayama
authors: Akiko
authors: A
authors: Komiya
authors: Hiroshi
authors: H
authors: Furukawa
authors: Toshihiro
authors: T
authors: Matsui
authors: Shigeto
authors: S
authors: Tohma
mesh_terms: D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D003520:Cyclophosphamide / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D014890:Granulomatosis with Polyangiitis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008279:Magnetic Resonance Imaging; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D053146:Myeloblastin / Q000276:immunology; D011239:Prednisolone / Q000008:administration & dosage; D013788:Thalamus; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D015415:Biomarkers; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D011239:Prednisolone; D053146:Myeloblastin; D008775:Methylprednisolone