SHM Converge Scientific Abstract ePoster Gallery-Falling, Numbness, and a Stuffy Nose: An Unexpected Diagnosis of Granulomatosis With Polyangiitis

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This case report describes a 70-year-old man whose granulomatosis with polyangiitis (GPA) initially presented with chronic sinusitis and progressive peripheral neuropathy rather than the more typical renal or pulmonary disease. He had four months of antibiotic-refractory sinus symptoms, unintentional weight loss, rash, worsening distal numbness and electric-shock sensations, weakness, right foot drop, and gait instability leading to a fall. Examination showed marked muscle wasting, sensory loss, reduced reflexes, and inability to walk independently.<br /><br />Laboratory testing revealed inflammation, anemia, thrombocytosis, hyponatremia, and markedly elevated ESR and CRP. Infectious and common autoimmune studies were negative. Imaging demonstrated chronic pansinusitis without malignancy or spinal cord disease. Serology showed strongly positive c-ANCA and PR3 antibodies, supporting GPA. Electromyography found a subacute patchy axonal polyradiculoneuropathy, and sural nerve biopsy confirmed necrotizing vasculitic neuropathy affecting large arterioles.<br /><br />The report emphasizes that GPA is a small- to medium-vessel necrotizing vasculitis affecting the respiratory tract and kidneys, but peripheral neuropathy can occur in up to 19% of cases and may rarely be the first or dominant manifestation. In this patient, neuropathy and chronic sinusitis were key clues to the diagnosis.<br /><br />The main clinical message is to consider vasculitis in patients with chronic sinusitis that does not respond to antibiotics, especially when neurologic symptoms are present. Early ANCA testing, specialist involvement, and nerve biopsy can prevent diagnostic delay. Prompt immunosuppressive treatment may stabilize disease and improve outcomes, although neurologic recovery may remain incomplete.

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John Cerillo

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Author List Adrian Dumitrascu, Aya Elalfy, Claire Overholt, Claire Wilson, Colt C. Cowdell, Daniel Matloff, Emily Gansert, John Cerillo, Melissa Cortes, Michael Smerina, Tatjana Gavrancic

Category Clinical Vignettes

Concept Granulomatosis with Polyangiitis

Concept Mononeuritis Multiplex

Concept Antibiotic-Refractory Sinusitis

Concept Peripheral Neuropathy

Concept Vasculitic Neuropathy

Distinguished Non-Finalist

Presenter Organization Department of Internal Medicine at Mayo Clinic Florida

Presenting Author John Cerillo

Track Adult

Keywords

granulomatosis with polyangiitis

GPA

chronic sinusitis

peripheral neuropathy

vasculitic neuropathy

c-ANCA

PR3 antibodies

necrotizing vasculitis

foot drop

nerve biopsy

Granulomatosis with Polyangiitis

Mononeuritis Multiplex

Antibiotic-Refractory Sinusitis

Peripheral Neuropathy

Vasculitic Neuropathy