A Fulminant Case of Granulomatosis with Polyangiitis with Meningeal and Parenchymal Involvement.
Central nervous system (CNS) involvement, such as pachymeningitis and/or cerebrovascular events, is rare in patients with granulomatosis with polyangiitis (GPA). Furthermore, the details of pathological examinations of cases have rarely been described. We describe a case of GPA that manifested as an isolated paranasal sinus disease that invaded the subarachnoid space and caused a hemorrhagic venous infarction. We also describe the pathological characteristics of the biopsied brain material from the successful decompressive craniectomy. In particular, granulomatous inflammation with geographic necrosis and multinucleated giant cells were observed in the perivascular area of the thickened dura mater and leptomeninges. Small vessels in the meninges were involved in the granulomatous lesions, and the lumens of the veins were often occluded. In the cerebral cortices and white matter in these areas, hemorrhagic infarction was widely observed. We suggest that our findings represent a novel mechanism of CNS involvement in GPA. Moreover, we believe that the emergency decompressive craniectomy and partial lobectomy for the cerebral infarction in this patient with GPA likely contributed to his survival.
Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan.
Ryuji
R
Yajima
Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan.
Yasuko
Y
Toyoshima
The Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
Yoko
Y
Wada
Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan.
Tetsuya
T
Takahashi
Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan.
Hiroyuki
H
Arakawa
Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan.
Gaku
G
Ito
The Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
Daisuke
D
Kobayashi
Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan ; Department of Clinical Research, Saigata Medical Center, National Hospital Organization, Niigata, Japan.
Mitsunori
M
Yamada
Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan.
Izumi
I
Kawachi
The Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
Ichiei
I
Narita
Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan.
Hitoshi
H
Takahashi
Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan.
Masatoyo
M
Nishizawa
Craniectomy; Granulomatosis with polyangiitis; Pachymeningitis; Proteinase 3-anti-neutrophil cytoplasmic antibody; Venous infarction