title: Granulomatosis with polyangiitis and multiple bilateral cranial nerve palsies: a diagnostic challenge.
abstract: BACKGROUND
  Granulomatosis with polyangiitis is characterized by vasculitis of small and medium sized vessels and non-caseating granulomas with head and neck symptoms in 95% of those affected. Cranial nerve palsies are rare; while, chronic rhinosinusitis and ear problems are common.
  
  
  METHODS
  We describe the serious course and the diagnostic challenge of a patient with granulomatosis with polyangiitis of bilateral mastoids and the right temporal lobe. Initially, the patient showed metachronous bilateral facial palsy with chronic mastoiditis. Repeated surgeries and rheumatologic examinations did not determine a diagnosis. The patient developed additional cranial nerve palsies. Due to progression into the temporal lobe, we removed the affected parts. After 6 months, the diagnosis was revealed by histology.
  
  
  CONCLUSIONS
  Granulomatosis with polyangiitis is a diagnostic challenge. Persistent reevaluations were necessary for a final diagnosis and to limit the life-threatening disease. Once diagnosed, therapy began with the standard FAUCI-Scheme.
authors: J
authors: J
authors: Kristin
authors: C
authors: C
authors: Beutner
authors: T
authors: T
authors: Klenzner
authors: F B
authors: FB
authors: Knapp
mesh_terms: D003389:Cranial Nerve Diseases / Q000209:etiology*; D005158:Facial Paralysis / Q000209:etiology; D005260:Female; D014890:Granulomatosis with Polyangiitis / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D008417:Mastoiditis / Q000209:etiology; D008875:Middle Aged