An eosinophilic variant granulomatosis with polyangiitis involving the dura, bilateral orbits, and mastoids.
Granulomatosis with polyangiitis (GPA) formerly called Wegener's granulomatosis is a chronic necrotizing granulomatous inflammatory disease with systemic vasculitis involving the upper and lower respiratory tract, and kidneys. The typical histopathology is that of necrotizing granulomatous inflammation with palisading histiocytes, neutrophils, and lymphocytes. We report a case of a 57-year-old lady presenting with left eye swelling, left ear pain and discharge, but with no pulmonary or renal symptoms. Investigations revealed positive cytoplasmic antineutrophil cytoplasmic antibodies  and proteinase 3 antibodies. The CT and MRI showed meningeal thickening and bilateral structural changes of the orbits and mastoids. Lacrimal gland biopsy showed non necrotizing granulation with an eosinophilic infiltration. She was diagnosed with eosinophilic variant of GPA of the eyes and mastoid bones bilaterally extending to dura and sparing the lungs and kidneys. She responded to corticosteroids and rituximab.
Department of Medicine, Rheumatology Division, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail. zumaigahoo@yahoo.com.
Hasan
H
Al-Hakami
Abdurhman S
AS
Al-Arfaj
Mohammed
M
Al-Sohaibani
Najma A
NA
Khalil
D004802:Eosinophilia / Q000150:complications*; D005260:Female; D014890:Granulomatosis with Polyangiitis / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008416:Mastoid / Q000473:pathology*; D008875:Middle Aged; D009915:Orbit / Q000473:pathology*