title: Granulomatosis with polyangiitis: recurrence presenting as ependimoplexitis.
abstract: A 55-year-old man with granulomatosis with polyangiitis (GPA) developed continuous parietal headache, malaise, nasal crusting and dry cough. Neurological exam revealed only left hand hypoesthesia in 4th and 5th finger. Brain MRI showed enlarged right choroid plexus, hyperintense periventricular white matter, thalami and right side of corpus callosum. The suspected diagnosis was ependimoplexitis due to GPA, the patient received three 500 mg methylprednisolone pulses followed by 1 mg/kg of meprednisone with gradual tapering and was switched to oral cyclophosphamide. He had complete resolution of headache. An MRI following this treatment for relapse revealed only minimal ependimal changes.
authors.affiliation: Section of Rheumatology and Immunology, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina. ceciliapisoni@gmail.com.
authors.forename: Cecilia N
authors.initials: CN
authors.lastname: Pisoni
authors.forename: Soledad
authors.initials: S
authors.lastname: Ibañez
authors.forename: Martín
authors.initials: M
authors.lastname: Guevara
authors.forename: Diego
authors.initials: D
authors.lastname: Castro
authors.forename: Silvana
authors.initials: S
authors.lastname: Romero Vidomlansky
mesh_terms: D002831:Choroid Plexus / Q000473:pathology*; D003520:Cyclophosphamide / Q000008:administration & dosage*; D003937:Diagnosis, Differential; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D014890:Granulomatosis with Polyangiitis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D009460:Neurologic Examination / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D020293:Vasculitis, Central Nervous System / Q000175:diagnosis / Q000209:etiology
chemical_list: D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D008775:Methylprednisolone