CC BY
2mediterranean journal
of RHEUMATOLOGY
33 1
2022
©Syrmou V, Simopoulou T, Bogdanos DP, Alexiou I.
This work is licensed under a Creative Commons Attribution 4.0 International L
©CD
CLINICAL IMAGE
Saddle Nose with Recurrent Sinusitis and Arthralgias: a Not-to-lose Diagnosis
Vassiliki Syrmou, Theodora Simopoulou, Dimitrios P. Bogdanos, Ioannis Alexiou
Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Thessaly, General University Hospital of Larissa, Larissa, Greece
Mediterr J Rheumatol 2022;33(1):91 https://doi.org/10.31138/mjr.33.1.91
Article Submitted: 10 Mar 2022; Article Accepted: 20 Mar 2022; Available Online: 31 Mar 2022
Nasal and lung features in a patient with Granulomatosis with Polyangii-tis (GPA, formerly called Wegener's). A 39-year-old man presented with a 6-month history of recurrent sinusitis, nose deformity (Figure 1A), low grade fever and arthralgias. ENT examination revealed nasal septum perforation (Figure 1B), and sensorineural hearing loss. He complained about dry cough and CT thorax (Figure 2) revealed multiple granulomas bilaterally. Nasal mucosa biopsy revealed signs of acute and subacute inflammatory changes with infiltration of neutrophils and histiocytes. From urine microscopy there was microscopic haema-turia with glomerular red blood cells. Patient had high c-ANCA (1/160) and PR3(>100 RU/ml, NV<20 RU/ml) titre. After setting the diagnosis of polyar-teritis with granulomatosis (PGA), symptoms regressed with methylprednisolone pulses and cyclophosphamide. Despite immunosuppression, nasal septum deformity requires surgical repair.
CONFLICT OF INTEREST
The authors declare no conflict of interest.
Corresponding Author:
Ioannis Alexiou
Department of Rheumatology and Clinical Immunology
General University Hospital of Larissa, 40110 Larissa, Greece E-mail: ioalexiou@uth.gr
Figure 1. (A) saddle nose on profile; (B) nasal septum perforation with hyperplasia of the nasal mucosa.
Figure 2. CT thorax with pulmonary granulomas.
Cite this article as: Syrmou V, Simopoulou T, Bogdanos DP, Alexiou I. Saddle Nose with Recurrent Sinusitis and Arthralgias: a Not-to-lose 91 Diagnosis. Mediterr J Rheumatol 2022;33(1):91.
