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Título

Granulomatosis with polyangiitis as a differencial diagnosis in intensive care unit: a case report

Fundamentação/Introdução

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.

Objetivos

Objective: Draw attention to granulomatosis with polyangiitis as a differential diagnosis in intensive care unit patient with pulmonary sepsis.

Delineamento/Métodos

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.

Resultados

The diagnosis was granulomatosis with polyangiitis, treated with methylprednisone pulse therapy and cyclophosphamide, progressing to clinical stability and receiving discharge with outpatient follow-up.

Conclusões/Considerações finais

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.

Palavras Chaves

Ganulomatosis with polyangiitis; differencial diagnosis; sepsis; intensive care

Área

Clínica Médica

Instituições

Niterói D'or - Rio de Janeiro - Brasil

Autores

Maitê Domingos Almeida, Anna Luiza Araujo Neurauter, Karen Abreu Lima, Rodrigo Marins Féres, Mateus Freitas Teixeira

Promoção

SBCM

Realização

SBCM MG
ABRAMURGEM

Patrocínio Ouro

UNIFENAS

Patrocínio Prata

Unimed - BH

Patrocínio Bronze

CUREM
SENIOR VILLAGE

Apoio

IPSEMG
TAKEDA

Agência de Turismo

Belvitur

Organização

Attitude Promo

Agência Web

Sistema de Gerenciamento desenvolvido por Inteligência Web

14º Congresso Brasileiro de Clínica Médica e 4º Congresso Internacional de Medicina de Urgência de Emergência

MINASCENTRO - Belo Horizonte/MG | 04 a 06 de Outubro de 2017