Granulomatosis with polyangiitis

Clinic

• GPA previously known as Wegener's granulomatosis (WG)
• It is a rare long-term systemic disorder that involves the formation of granulomas and vasculitis
• It affects small- and medium-size vessels in many organs but most commonly affects the upper respiratory tract, lungs and kidneys.

Signs / Symptoms

• Involvement of the upper respiratory tract, such as the nose and sinuses
  • Crusting around the nose, Stuffiness, Nosebleeds, Runny nose, and saddle-nose deformity due to a hole in the septum of the nose.
  • Scleritis, Episcleritis, Conjunctivitis

• Rapidly progressive glomerulonephritis (75%)
• Conductive hearing loss due to auditory tube dysfunction, sensorineural hearing loss
• Strawberry gingivitis, Loosening of teeth.
• Trachea: subglottal stenosis
• Lungs: Pulmonary nodules (referred to as "coin lesions"), infiltrates (often interpreted as pneumonia), cavitary lesions, bleeding in the lungs causing a person to cough up blood, and rarely bronchial stenosis.
• Arthritis (60%)
• Subcutaneous nodules (granulomas) on the elbow, purpura, various others (see cutaneous vasculitis)
• Sensory neuropathy (10%) and rarely mononeuritis multiplex
• Heart, gastrointestinal tract, brain, other organs: rarely affected.

Entities

• Vasculitis
• Nephritis
• Arthritis
• Nose, Coryza
• Neuropathy

Miasms

• B19
• MTB is good candidate but it dose not cover nephritis