title: The role of conjunctival biopsy in the diagnosis of granulomatosis with polyangiitis.
abstract: BACKGROUND
  The purpose of this study is to describe a patient who was diagnosed with granulomatosis with polyangiitis based on conjunctival biopsy. This study is a case report and review of the literature.
  
  
  RESULTS
  A 48-year-old Caucasian woman presented with a 2-week history of a left eye peripheral corneal ulcer with adjacent conjunctivitis and a 4-month history of a non-resolving productive cough. Given her elevated serum perinuclear antineutrophil cytoplasmic antibody (P-ANCA) and erythrocyte sedimentation rate (ESR) levels as well as a chest computed topography (CT) that showed bilateral patchy infiltrates, suspicion of limited granulomatosis with polyangiitis with lung and ocular involvement was high. Because bronchoalveolar lavage was nondiagnostic for granulomatous disease, conjunctival biopsy was initially attempted in order to avoid a more invasive lung biopsy. The conjunctival biopsy revealed mixed subacute inflammatory mediators and vasculitis consistent with granulomatosis with polyangiitis.
  
  
  CONCLUSIONS
  Conjunctival biopsy may be a valuable, minimally invasive method for diagnosing systemic granulomatosis with polyangiitis.
authors: Department of Ophthalmology and Vision Science, College of Medicine, University of Arizona, Tucson, AZ 85711 USA.
authors: Roxana
authors: R
authors: Ursea
authors: Oculoplastics Service, Massachusetts Eye and Ear Infirmary, Boston, MA 02114 USA.
authors: Dawn
authors: D
authors: De Castro
authors: College of Medicine, University of Arizona, Tucson, AZ 85711 USA.
authors: Trent J
authors: TJ
authors: Bowen
authors: Immunopathology Section, National Eye Institute, Bethesda, MD 20892 USA.
authors: Chi-Chao
authors: CC
authors: Chan
keywords: Biopsy; Conjunctivitis; Cornea; Granulomatosis with polyangiitis; Ulceration
references: JAMA. 1975 Aug 25;233(8):868-71
references: 1173895
references: Q J Med. 1994 Mar;87(3):161-7
references: 8208904
references: Ophthal Plast Reconstr Surg. 2006 Jan-Feb;22(1):69-71
references: 16418677
references: Semin Arthritis Rheum. 2013 Apr;42(5):507-14
references: 23270762
references: Ophthalmology. 1992 Jan;99(1):120-4
references: 1741123
references: Kidney Int. 1994 Jul;46(1):1-15
references: 7933826
references: Surv Ophthalmol. 1998 Mar-Apr;42(5):458-80
references: 9548575
references: Arthritis Rheum. 1990 Aug;33(8):1101-7
references: 2202308
references: Ophthalmology. 2003 Sep;110(9):1770-80
references: 13129876
references: Am J Med. 1977 Jul;63(1):131-41
references: 327802
references: Arthritis Rheum. 2009 Jun;60(6):1578-87
references: 19479864
references: Can J Ophthalmol. 2002 Apr;37(3):179-81
references: 12083477
references: Am J Med. 1970 Sep;49(3):366-79
references: 4917075
references: Clin Exp Ophthalmol. 2006 Jan-Feb;34(1):51-3
references: 16451259
references: Clin Exp Immunol. 1998 Oct;114(1):113-8
references: 9764612
references: Am J Med. 1966 Oct;41(4):497-527
references: 5923596
references: Ophthalmology. 1994 Mar;101(3):602-7
references: 8127582
references: Surv Ophthalmol. 2010 Sep-Oct;55(5):429-44
references: 20638092
references: Mayo Clin Proc. 1969 Sep;44(9):649-63
references: 4390370
references: Ann Intern Med. 1983 Jan;98(1):76-85
references: 6336643
references: Ophthalmology. 1983 Mar;90(3):279-90
references: 6602963
references: Ann Intern Med. 1992 Mar 15;116(6):488-98
references: 1739240
references: Lancet. 1985 Feb 23;1(8426):425-9
references: 2857806