A case of granulomatosis with polyangiitis: rheumatoid arthritis overlap syndrome presenting as cervical cancer successfully treated with rituximab

Campochiaro, Corrado; Scotti, Raffaella; Margari, Sergio; Giorgione, Veronica; Mellone, Renata; Mangili, Giorgia; Maschio, Alessandro Del; Tresoldi, Moreno

doi:10.1111/imj.13090

Cited by 4 publications

(8 citation statements)

References 3 publications

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“…Once studies with patients with MPA or EGPA (5) were removed, a total of 17 studies fulfilled all inclusion criteria and were selected for full-text evaluation and systematic review [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. After reviewing the 17 articles, 18 patients were identified as GPA with gynecological involvement (two patients reported by Stone et al) [12].…”

Section: Main Findingsmentioning

confidence: 99%

“…The results are shown in Tables 1 and 2. In thirteen of the 19 patients (68%) [14][15][16][17][18][20][21][22][24][25][26][27][28],including our case, the authors considered gynecologic cancer as the first possibility of diagnosis. Among them, 11 (58%) thought they were dealing with cervical cancer [14][15][16][17][18]21,22,[24][25][26][27][28].…”

Section: Main Findingsmentioning

confidence: 99%

“…In thirteen of the 19 patients (68%) [14][15][16][17][18][20][21][22][24][25][26][27][28],including our case, the authors considered gynecologic cancer as the first possibility of diagnosis. Among them, 11 (58%) thought they were dealing with cervical cancer [14][15][16][17][18]21,22,[24][25][26][27][28]. Isolated genital involvement and multi-site involvement were present in 10 and in 9 out of 19 patients, respectively (43%).…”

Section: Main Findingsmentioning

confidence: 99%

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Granulomatosis with Polyangiitis-Mimicking Advanced Gynecological Cancer: A Case Report and Systematic Review of the Literature

Pereira

Magrina

Magtibay

et al. 2022

JPM

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(1) Background: Granulomatosis with polyangiitis (GPA) is a necrotizing vasculitis that mimics gynecologic cancer. In GPA patients, the genitourinary system is affected in <1%. The objective of the study was to provide a systematic review of the literature of GPA patients with gynecological involvement. (2) Methods: PubMed and Embase were searched from inception to July 2021 for GPA patients with gynecological involvement Medical Subject Headings (MeSH) and free-text terms. Exclusion criteria were other language, review articles, pregnancy, fertility, or male patients. Data were extracted on clinical evolution, symptoms, examinations findings, diagnosis delay, treatment, outcome, patient status, and follow-up. (3) Results: Seventeen studies included data from patients with GPA and primary or relapsed gynecological involvement. 68% of the authors of this review thought the patient had cancer. The main gynecological symptom is bleeding, but exclusive gynecologic symptomatology is rare (ENT: 63%, lungs: 44%, kidneys-urinary tract: 53%). GPA could affect all areas of the genital tract, but the most frequent location is the uterine cervix. Medical treatment for GPA is effective. (4) Conclusions: GPA of the female genital tract must be considered when biopsies of an ulcerated malignant-appearing cervical or vaginal mass are negative for malignancy even when they are unspecific. Rheumatology consultation is indicated.

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Section: Main Findingsmentioning

confidence: 99%

Section: Main Findingsmentioning

confidence: 99%

Section: Main Findingsmentioning

confidence: 99%

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Granulomatosis with Polyangiitis-Mimicking Advanced Gynecological Cancer: A Case Report and Systematic Review of the Literature

Pereira

Magrina

Magtibay

et al. 2022

JPM

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“… Guo 2012 [ 4 ] M 60 66 RA 6 y small joint deformities + RF, & radiographs Chronic rhinosinusitis, bilateral lung nodule, facial ulcer & bx: granulomatous inflammation and vasculitis Steroids, Cyc, & IVIG. Parekh 2010 [ 10 ] F 49 58 RA 9 y Erosive RA Hemoptysis, sinusitis, CT chest: bilateral cavitating lung nodules, + PR3 ANCA, & Tracheal bx: extensive infarction and inflammation with necrotizing vasculitis Steroids & MTX Ohashi 1991 [ 6 ] F 33 38 RA 5 y Synovitis, deformity, +RF, & X-rays: joint space narrowing Perforated nasal septum, saddle nose & nasal cavity bx: arteritis with cellular infiltration, giant cells & epidermoid cells Steroids & Cyc Campochiaro 2016 [ 11 ] F 35 55 RA 20 y Small joint synovitis & + RF Proteinuria, CT: pulmonary excavated lesions, nasal septum erosions, + PR3 ANCA, skin bx: pauci-immune vasculitis, & neck mass bx: necrotizing granulomatous inflammation. Steroids, Cyc, & rituximab.…”

Section: Tablementioning

confidence: 99%

“…GPA and RA have shared features including vasculitis, ocular inflammation, interstitial lung disease, and arthritis but existing evidence indicates they are distinct conditions. Interestingly, the co-existence of GPA and RA has been described in the literature [ 1 - 11 ]. Herein, we report two cases of GPA developing in patients with underlying RA and examine the relationship between the two conditions.…”

Section: Introductionmentioning

confidence: 99%

The Co-existence of Rheumatoid Arthritis and Granulomatosis With Polyangiitis: Two Cases and Review of the Literature

Hassan¹,

Edigin²,

Patel³

et al. 2021

Cureus

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Granulomatosis with polyangiitis (GPA) and rheumatoid arthritis (RA) have shared features including vasculitis, ocular inflammation, interstitial lung disease, and arthritis but existing evidence indicates they are distinct conditions. Interestingly, the co-existence of GPA and RA has been described in the literature. Herein, we report two cases of GPA developing in patients with underlying RA and examine the relationship between the two conditions. Two cases of GPA that developed in patients with preexisting RA are described in detail. Additionally, PubMed was searched for articles in English showing an association of RA and GPA using keywords “rheumatoid arthritis, and vasculitis, and Wegener’s, and ANCA, and granulomatosis polyangiitis.” In addition to our two cases of RA and GPA overlap, 14 reports were identified in PubMed library from 1970 to 2020. Most of the cases were females (14/16, 88%), and had RA as the initial diagnosis (15/16, 94%). The mean age of RA diagnosis was 45.5 years, the mean age of GPA diagnosis was 52 years and the mean interval between both diagnoses was 101 months. Cyclophosphamide and steroid therapy were used in most of the cases. There are numerous reports of GPA and RA overlap in the literature. GPA should be considered in the differential diagnosis when vasculitis develops in patients with RA.

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Prevalence of overlap of antineutrophil cytoplasmic antibody associated vasculitis with systemic autoimmune diseases: an unrecognized example of poliautoimmunity

2018

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We aimed to estimate the frequency of overlap of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) with systemic autoimmune diseases. Retrospective single-center study to identify patients with AAV diagnosis and concomitant autoimmune systemic diseases, simultaneously, before or after the diagnosis of AAV. Sociodemographic characteristics, such as comorbidities; follow-up time; type of AAV; disease duration; relapses; treatment and response; clinical, serological, and histological characteristics; disease activity and damage; prognosis; dialysis requirements, and death were assessed. Twenty-eight of two hundred and forty-seven patients (11.3%) with AAV had a concomitant diagnosis of autoimmune disease. The predominant AAV type was renal-limited vasculitis (39%), followed by granulomatosis with polyangiitis (29%), mycroscopic polyangiitis (25%), and eosinophilic granulomatosis with polyangiitis (7%). Mean age at AAV diagnosis was 50 ± 17 years and 24/28 were ANCA positive. The main clinical manifestations were renal (79%), otorhinolaryngologic (43%), and pulmonary and peripheral neuropathy (32%). Sixteen patients (57%) experienced partial or total remission at a median follow-up of 34 months, and four patients (14%) died. The most frequent autoimmune disease overlapped was rheumatoid arthritis (39%), followed by Sjögren's syndrome and systemic sclerosis (14%), mixed connective tissue disease (11%), systemic lupus erythematosus and juvenile idiopathic arthritis (7%), and ankylosing spondylitis and IgG4-related disease (4%). In nine patients (32%), both diagnoses were simultaneous; in the rest, median time elapsed between the autoimmune disease and AAV diagnosis was 173 months. The prevalence of overlap AAV with other autoimmune diseases was low. The most common AAV phenotype was renal-limited vasculitis, and the most frequent overlap disease was rheumatoid arthritis.

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A case of granulomatosis with polyangiitis: rheumatoid arthritis overlap syndrome presenting as cervical cancer successfully treated with rituximab

Cited by 4 publications

References 3 publications

Granulomatosis with Polyangiitis-Mimicking Advanced Gynecological Cancer: A Case Report and Systematic Review of the Literature

Granulomatosis with Polyangiitis-Mimicking Advanced Gynecological Cancer: A Case Report and Systematic Review of the Literature

The Co-existence of Rheumatoid Arthritis and Granulomatosis With Polyangiitis: Two Cases and Review of the Literature

Prevalence of overlap of antineutrophil cytoplasmic antibody associated vasculitis with systemic autoimmune diseases: an unrecognized example of poliautoimmunity

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