title: Hypertrophic Pachymeningitis as a Delayed Complication of Granulomatosis with Polyangiitis.
abstract: A 69-year-old man presented with upper airway symptoms, multiple lung nodules and masses, proteinuria and hematuria, and an increased level of proteinase 3 anti-neutrophil cytoplasmic antibody (PR3-ANCA). Granulomatosis with polyangiitis (GPA) was diagnosed by a transbronchial lung biopsy. All of these symptoms were ameliorated and the level of PR3-ANCA declined following treatment with prednisolone and cyclophosphamide. The patient developed a headache 16 months after the onset of symptoms, and contrast-enhanced magnetic resonance imaging showed the thickening of the dura mater, which suggested that hypertrophic pachymeningitis (HP) had developed as a complication of GPA. HP can be a unique complication of GPA at recurrence, and can occur without the relapse of other lesions or an increase in PR3-ANCA level.
authors.affiliation: Second Department of Internal Medicine, Nara Medical University, Japan.
authors.forename: Makiko
authors.initials: M
authors.lastname: Kumamoto
authors.forename: Koichi
authors.initials: K
authors.lastname: Tomoda
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Furuya
authors.forename: Naoki
authors.initials: N
authors.lastname: Iwasa
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ueno
authors.forename: Masanori
authors.initials: M
authors.lastname: Yoshikawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kimura
mesh_terms: D000368:Aged; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000276:immunology; D003520:Cyclophosphamide / Q000008:administration & dosage*; D004388:Dura Mater / Q000473:pathology*; D014890:Granulomatosis with Polyangiitis / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D006261:Headache / Q000209:etiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008279:Magnetic Resonance Imaging; D008297:Male; D008581:Meningitis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D053146:Myeloblastin / Q000276:immunology; D011239:Prednisolone / Q000008:administration & dosage*; D011507:Proteinuria / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D011239:Prednisolone; D053146:Myeloblastin