Wegener's Granulomatosis in a Patient with a Rheumatoid Arthritis.

Ohashi, Hiroyuki; Itoh, Mitsuyasu; Ogawa, Noriyoshi; Sudo, Y; Endo, Shiori; Okugawa, Tadamasa; Ito, Hisako; Mineta, Hiroyuki; Nozue, Michihiko

doi:10.2169/internalmedicine.31.1128

Cited by 17 publications

(6 citation statements)

References 16 publications

(14 reference statements)

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“…RA has been rarely reported to be associated with WG (7)(8)(9). In the present case, the long-standing disease duration and the characteristic symmetrical deformities of multiple small joints of the extremities confirmed the coexistence of RA and excluded the possibility of prodromal symptoms for WG from long-lasting polyarthralgia and elevated RF.…”

Section: Discussionmentioning

confidence: 99%

Chronic Unilateral Facial Ulcer Revealing Wegener’s Granulomatosis in a Patient with Rheumatoid Arthritis

Guo¹,

Liu²,

Zheng³

et al. 2013

Acta Derm Venerol

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Wegener's granulomatosis (WG) is an autoimmune multisystem small-vessel vasculitis (1). The incidence of cutaneous manifestations of WG (nodules, ulcers, purpura, petechiae, haemorrhagic pustules, erythematous papules and plaques) was reported to range from 28 to 64% (2, 3). We report here the case of a 66-year-old man who presented with chronic unilateral facial ulcer and was proven to have biopsy-confirmed WG. It is noteworthy that the patient had pre-existing rheumatoid arthritis (RA), cutaneous candidiasis and onychomycosis. CASE REPORTA 66-year-old Chinese man presented with an 8-month history of non-painful ulcer on the left face. He had a lO-year history of arthritis of the extremities, resulting in symmetrical deformities of multiple small joints of the hands and feet. He was diagnosed with RA by typical clinical manifestations, elevated serum rheumatoid factor (RF) and typical X-ray findings in the department of rheumatology 6 years ago. He had intermittently administered low-dose prednisone since then. A productive cough with bloody sputa developed 2 years before presentation. He bad a 30-year history of cigarette smoking. He had no history of tuberculosis or tuberculosis exposure. A purified protein-derivative skin test was negative.Physical examination revealed a7x9xll.5cm deltoid-shaped sharply marginated ulcer on his left face, with erythematous elevated borders, puruloid exudates, bloody crusts and irregular shaped hypertrophie scars in the centre (Fig. 1 A). White patches were observed involving the proximal regions of 4 toenails (Fig. SIH; available from bttp://www.medicaljoumals.se/acta/conte nt/?doi=10.2340/00015555-1405). Bilateral ballux valgus and stacking of the second and third toes on top of the great toe were also seen (Fig. SIH).Laboratory tests showed a total white blood cell (WBC) count of 20.45x1071 (3.97-9.15), leukocytosis (88.1%), elevated platelet 579x1071 (85-303), and reduced haemoglobin 89 g/1 (131-172). Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), RF and anti-streptolysin O (ASO) were 84 mm/b, 140 mg/dl (0-8), 2470 IU/ml (0-30) and 649 IU/ml (0-116), respectively. Serum y globulin was 31.4% (11.6-24.4). Serological tests for cytoplasmic anti-neutrophil cytoplasmic antibodies (c-ANCA) and perinuclear ANCA were negative. Serum antibodies against HIV and syphilis were negative. Serum 1,3-ß-D-glucan was negative.Direct smears of thrush, sputum and pus in the ulcer showed spores and pseudohyphae, and cultures revealed Candida albicans. Deep scrapings of the white patches of the toenails and potassium hydroxide preparation from the materials showed numerous hyphae. Cultures on Sabouraud glucose agar revealed colonies of Trichophyton rubrum. Gram stains, bacterial cultures, acid-fast bacilli smears and mycobacterial cultures of pus and sputum were negative.The biopsy specimen of the border of the ulcer showed necrosis with a dense infiltrate of mixed inflammatory cells composed Fig.

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Section: Discussionmentioning

confidence: 99%

Chronic Unilateral Facial Ulcer Revealing Wegener’s Granulomatosis in a Patient with Rheumatoid Arthritis

Guo¹,

Liu²,

Zheng³

et al. 2013

Acta Derm Venerol

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“…To our knowledge, this is the first study which focussed on chemosensory function in WG patients. Two previous case reports [14,15] and one large series on cranial nerve involvement in Wegener disease mention anecdotally chemosensory symptoms without having measured and them [16]. Recently, Laudien et al [17] also screened WG patients for olfactory identification suggesting that up to 18% of them had lowered olfactory identification scores.…”

Section: Discussionmentioning

confidence: 99%

Chemosensory function in Wegener’s granulomatosis: a preliminary report

Göktas¹,

Van

Fleiner³

et al. 2009

Eur Arch Otorhinolaryngol

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Despite the fact that Wegener's granulomatosis affects the nasal and paranasal cavities and the cranial nerves regularly, chemosensory impairments have not been reported. The objective of this study is to test the three chemosensory systems, olfaction, taste, and intranasal trigeminal function in Wegener disease patients. We tested olfactory, gustatory, and intranasal trigeminal function in nine patients (5 women, 4 men, mean age 57 years) with confirmed Wegener's granulomatosis. Olfaction was tested with the Sniffin'Sticks, gustatory function with the "Taste strips" and intranasal trigeminal function with a lateralization task. One patient had anosmia (11%), four patients had hyposmia (44%) and four patients were normosmic (45%). Gustatory testing function showed pathological taste strip results in five patients (55%) and normal results in three patients (33%). One patient did not undergo taste testing. Intranasal trigeminal function was lowered in five patients (56%) and normal in four patients (44%). Neither previous nasal surgery status nor endoscopic status was associated to a higher frequency in pathological scores for any of the three chemical senses. In conclusion, these preliminary results suggest a consistent affection in chemosensory functions in Wegener's granulomatosis patients.

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“…Only a few cases of WG complicated by typical RA have been reported (12,13). Polyarthralgia is a relatively common symptom in WG patients, but arthritis is transient and non-destructive (12,14).…”

Section: Discussionmentioning

confidence: 99%

“…As the etiology of WG is still unknown, the pathogenesis of overlapping diseases is obscure. Ohashi et al (12), however, suggested that a common etiological factor implicated the production of an immune complex in a case of overlapping RA and WG.…”

Section: Discussionmentioning

confidence: 99%