Granulomatosis with polyangiitis of nasal mucosa diagnosed de novo in pregnancy

Czech version

Authors: M. Enter ; J. Syrovátka
Authors‘ workplace: Oddělení ORL a chirurgie hlavy a krku Nemocnice AGEL Nový Jičín a. s.
Published in: Otorinolaryngol Foniatr, 69, 2020, No. 4, pp. 177-180.
Category: Case Reports

Overview

Granulomatosis with polyangiitis, formerly known as Wegener´s disease, is a rare multisystemic disease of unknown cause. The peak incidence is observed at 40–60 years of age. In early stages, the disease manifests in ENT area as chronic rhinitis, recurrent epistaxis and sinusitis, followed by unspecific symptoms such as fever and anemia. The authors describe a case report of 32 years old pregnant woman in the third trimester with progressive bilateral nasal obstruction, which was later diagnosed as granulomatosis with polyangiitis localized solely in the nasal cavity. The initial treatment with glucocorticoids caused severe spasms with oxygen hyposaturation, this resulted in acute C-section. The authors discuss the diagnosis, symptoms, differential diagnosis and treatment of the disease that rarely manifests during pregnancy.

Keywords:

granulomatosis with polyangiitis – pregnancy – Wegener's granulomatosis – nasal obstruction

Sources

1. Bessias, N., Moulakakis, K. G., Lioupis, C., et al.: Wegener‘s granulomatosis presenting during pregnancy with acute limb ischemia. J Vasc Surg, 42, 2005, 4, s. 800–804.

2. Ellegard, E.: Special considerations in the treatment of pregnancy rhinitis. Womens Health (Lond), 1, 2005, 1, s. 105-114.

3. Erikson, V., Hwang, P. H.: Wegener´s granulomatosis: current trends in diagnosis and management. Curr Opin Otolaryngol Head Neck Surg, 15, 2007, 3, s. 170–176.

4. Ginat, D., Schatz, C. J.: Nasal Septum Granuloma Gravidarum. Ear Nose Throat J, 96, 2017, 10–11, s. 412–414.

5. Grygeiel-Górniak, B., Puszczewicz, M.: Granulomatosis with polyangiitis in pregnancy – clinical implications and treatment possibilities. Eur Rev Med Pharmacol Sci, 19, 2015, 13, s. 231–235.

6. Hemani, D. D., Gupta, A. K., Sharma, S. D., et al.: Recurrent bilateral pregnancy granuloma of the nose. J Laryngol Otol, 95, 1981, 9, s. 957–960.

7. Honsová, E.: Monitor aneb nemělo by vám uniknout, že Wegenerova granulomatóza byla přejmenována. Česk Patol, 57, 2012, 1, s. 8.

8. Chie, C. Y., Tai, C. F., Ho, K. Y., et al.: Nasal septum chondroma: a case report. Kaohsiung J Med Sci, 21, 2005, 3, s. 142–145.

9. Kalfeřt, P., Kašparová, P., Čelakovský, P.: Extranodální NK/T buněčný lymfom nazálního typu - neobvyklá příčina jednostranné nosní obstrukce. Otorinolaryngol Foniatr, 61, 2012, 2, s. 130–134.

10. Krishna, I., Balakrishman, K., Nirmal Kumar, B.: Pathology forum: quiz case4. Diagnosis: nasal granuloma gravidarum. Arch Otolaryngol Head Neck Surg, 126, 2000, 9, s. 1156–1160.

11. Lošťáková, V., Kolek, J., Vašáková, M., et al.: Granulomatóza s polyangiitidou. Sekce intersticiálních plicních procesů ČPFS, Vnitř Med, 16, 2014, 5, s. 199–201.

12. Liao, L. J., Lou, P. J.: Pyogenic Granuloma of the Nasal Cavity: An Unusual Complication of Pregnancy. Taiwan J Obstet Gynecol, 44, 2005, 1, s. 101–104.

13. Lin, T. I., Lin, J. C., Ho, E. S., et al.: Nasopharyngeal carcinoma during pregnancy. Taiwan J Obstet Gynecol. 46, 2007, 4, s. 423–426.

14. Miyazaki, M., Aoki, M., Oba, S., et al.: A rare case of dedifferentiated liposarcoma of the sinonasal cavity: A case report. Mol Clin Oncol, 7, 2017, 4, s. 539–542.

15. Noorizan, Y, Salina, H.: Nasal septal haemangioma in pregnancy. Med J Malaysia, 65, 2010, 1, s. 70–71.

16. Radice, A., Bianchi, L., Sinico, R.: Anti-neutrophil cytoplasmic autoantibodies: methological aspects and clinical signifikance in systemic vasculitis. Autoimmun Rev, 12, 2013, 4, s. 487–495.

17. Srouji, I., Andrews, P., Edwards, C., et al.: Patterns of presentation and diagnosis of patients with Wegener's granulomatosis: ENT aspects. J Laryngol Otol, 121, 2007, 7, s. 653–658.

18. Soh, M.C., Hart, H.H., Bass, E., et al.: Pregnancy complicating Wegener‘s granulomatosis. Obstet Med, 2, 2009, 3, s. 77–80.

19. Veltri, N. L., Hladunewich, M., Bhasin, A., et al.: De novo antineutrophil cytoplasmic antibody-associated vasculitis in pregnancy: a systematic review on maternal, pregnancy and fetal outcomes. Clin Kidney J, 11, 2018, 5, s. 659–666.