Granulomatosis with polyangiitis as a differencial diagnosis in intensive care unit: a case report
Introduction: Granulomatosis with polyangiitis, a small vessels vasculitis, involves mostly upper respiratory tract, lungs and kidneys. It’s a multisystemic pathology, with no sex predominance, affecting adults over 40 years old.
Objective: Draw attention to granulomatosis with polyangiitis as a differential diagnosis in intensive care unit patient with pulmonary sepsis.
Case report: K.S.D, 64 years, female, with chronic obstructive pulmonary disease and hypothyroidism, former smoker, came to emergency room with dyspnea, asthenia, cough and coryza, 15 days after a recurrent acute otitis media surgical treatment. Computed tomography chest scans showed bilateral pleural effusion, consolidation and a lung mass to be investigated. Admitted in Intensive Care Unit, treated for pulmonary sepsis. Subsequently, developed mastoiditis and conjunctival hyperemia and used several antibiotic therapys. A bronchoscopy with biopsy was realized, which showed an acute and chronic inflammatory infiltrate. She was discharged 40 days later, with clinical improvement. One month after discharge, was admitted again with pulmonary septic shock, in addition to sinusitis, polyarthralgia, purpura and acute renal injury, requiring hemodyalisis during hospitalization. Lung mass was no longer present at chest scans. Biomarkers were requested, such as c-ANCA, p-ANCA and rheumatoid factor, with positive result and antinuclear factor, with negative result. A renal biopsy also has been solicitated.
The diagnosis was granulomatosis with polyangiitis, treated with methylprednisone pulse therapy and cyclophosphamide, progressing to clinical stability and receiving discharge with outpatient follow-up.
Conclusion: Granulomatosis with polyangiitis is a rare condition, with a difficult diagnosis, that should be considered when patient presents upper respiratory tract, lungs and kidneys symptoms. Early diagnosis and immunosuppressive therapy are essential to reduce its morbimortality.
Ganulomatosis with polyangiitis; differencial diagnosis; sepsis; intensive care
Niterói D'or - Rio de Janeiro - Brasil
Maitê Domingos Almeida, Anna Luiza Araujo Neurauter, Karen Abreu Lima, Rodrigo Marins Féres, Mateus Freitas Teixeira