title: ANCA-negative Wegener's granulomatosis with multiple lower cranial nerve palsies.
abstract: Wegener's granulomatosis (WG) is a systemic vasculitis affecting small and medium-sized vessels with granulomatous formation. Though it is known for respiratory tract and kidney involvement, neurologic manifestation has been also reported. Herein we report a patient who suffered pansinusitis with multiple lower cranial nerve palsies but reached remission by immunosuppressant after the diagnosis of WG. A 54-yr-old female visited with headache, hearing difficulty, and progressive bulbar symptoms. She experienced endoscopic sinus surgeries due to refractory sinusitis. Neurologic examination revealed multiple lower cranial nerve palsies. Vasculitic markers showed no abnormality. Nasal biopsy revealed granulomatous inflammation and vasculitis involving small vessels. Given cyclophosphamide and prednisolone, her symptoms were prominently improved. WG should be considered in the patient with multiple cranial nerve palsies, especially those with paranasal sinus disease. Because WG can be lethal if delayed in treatment, prompt immunosuppressant is warranted after the diagnostic tissue biopsy.
authors.affiliation: Department of Neurology, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea.
authors.forename: Sung-Hee
authors.initials: SH
authors.lastname: Kim
authors.forename: Jin
authors.initials: J
authors.lastname: Park
authors.forename: Jung Ho
authors.initials: JH
authors.lastname: Bae
authors.forename: Min-Sun
authors.initials: MS
authors.lastname: Cho
authors.forename: Kee Duk
authors.initials: KD
authors.lastname: Park
authors.forename: Jee Hyang
authors.initials: JH
authors.lastname: Jeong
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D019268:Antibodies, Antineutrophil Cytoplasmic; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D003389:Cranial Nerve Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy; D003520:Cyclophosphamide / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005260:Female; D014890:Granulomatosis with Polyangiitis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy; D006801:Humans; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use; D011877:Radionuclide Imaging; D012852:Sinusitis / Q000601:surgery; D014657:Vasculitis
chemical_list: D000893:Anti-Inflammatory Agents; D019268:Antibodies, Antineutrophil Cytoplasmic; D018906:Antineoplastic Agents, Alkylating; D003520:Cyclophosphamide; D011239:Prednisolone
keywords: Cranial Nerve Diseases; Refractory Sinusitis; Wegener Granulomatosis; c-ANCA Negative