title: Granulomatosis with polyangiitis (Wegener granulomatosis) as a differential diagnosis of sternal osteomyelitis: the challenges in diagnosis.
abstract: Although granulomatosis with polyangiitis (GPA) can affect a large number of organ systems and produce a broad spectrum of clinical symptoms, skeletal involvement is very rare, with the exception of facial bone involvement associated with destructive nasal and sinus inflammation. We describe here a 54-year-old man with sternal osteomyelitis and destructive arthritis around the sternoclavicular joint. Despite antibiotics and conventional immunosuppressive treatment, his symptoms deteriorated, and a new mass-like lung lesion was developed. A histopathologic analysis of the lung mass revealed chronic granulomatous inflammation with fibrinoid necrosis, and he was diagnosed with GPA. When a patient with a destructive inflammatory lesion has negative culture results and no response to conventional therapy, we propose that an aggressive approach is necessary for a pathologic diagnosis to exclude the possibility of GPA.
authors.affiliation: From the Departments of *Internal Medicine and †Diagnostic Radiology, Daegu Fatima Hospital, and ‡Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.
authors.forename: Sang-Dong
authors.initials: SD
authors.lastname: Kim
authors.forename: Gun-Woo
authors.initials: GW
authors.lastname: Kim
authors.forename: Tae-Eun
authors.initials: TE
authors.lastname: Kim
authors.forename: Eun-Jung
authors.initials: EJ
authors.lastname: Nam
authors.forename: Seung-Woo
authors.initials: SW
authors.lastname: Han
mesh_terms: D003520:Cyclophosphamide / Q000008:administration & dosage; D003937:Diagnosis, Differential; D014890:Granulomatosis with Polyangiitis / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis*; D011877:Radionuclide Imaging; D013247:Sternoclavicular Joint / Q000000981:diagnostic imaging / Q000473:pathology; D013249:Sternum; D014057:Tomography, X-Ray Computed
chemical_list: D007166:Immunosuppressive Agents; D003520:Cyclophosphamide