title: Granulomatosis with polyangiitis (Wegener's granulomatosis) causing atlantoaxial instability: a case report.
abstract: No previous cases of atlantoaxial instability due to granulomatosis with polyangiitis have been reported.
  
  
  
  The aim of this study was to report a case of granulomatosis with polyangiitis causing atlantoaxial instability.
  
  
  
  This is a case report.
  
  
  
  A 45-year-old woman participated in this study.
  
  
  
  The patient's pain and atlantoaxial instability were resolved.
  
  
  
  A 45-year-old Caucasian woman with a large ulcerative lesion in her oropharynx initially presented with chronic sinusitis, pharyngitis, and severe odynophagia. Years after her original symptoms began, she developed neck pain radiating into her upper trapezial region and shoulders.
  
  
  
  Atlantoaxial fusion was performed on the patient, resolving her neck, upper trapezial, and shoulder pain. She was diagnosed with granulomatosis with polyangiitis (formerly Wegener's granulomatosis) and treated with cyclophosphamide.
  
  
  
  Granulomatosis with polyangiitis should be part of the working differential diagnosis for non-traumatic cervical spine injury. The atlantoaxial instability can be managed with stabilization, and the disease process itself can be treated with cyclophosphamide.
authors.affiliation: Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA. Electronic address: amohapatra@wustl.edu.
authors.forename: Anand
authors.initials: A
authors.lastname: Mohapatra
authors.affiliation: Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA.
authors.forename: Taleef
authors.initials: T
authors.lastname: Khan
authors.affiliation: ENT Center of Utah, 22 S 900 E, Salt Lake City, UT 84102, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Diaz
authors.affiliation: Department of Medicine, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8069, St. Louis, MO 63110, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Brasington
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8233, St. Louis, MO 63110, USA.
authors.forename: Lukas P
authors.initials: LP
authors.lastname: Zebala
mesh_terms: D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging; D005260:Female; D014890:Granulomatosis with Polyangiitis / Q000000981:diagnostic imaging* / Q000188:drug therapy; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging*; D008875:Middle Aged
keywords: Atlantoaxial instability; Atlantoaxial subluxation; Cervical spine; Granulomatosis with polyangiitis; Spinal fusion; Wegener's granulomatosis