Wegener’s Granulomatosis: Successful Treatment with High-Dose Cyclophosphamide

Abstract

A 30-year-old male taxi driver developed extensive purpuric necrotic lesions all over his body. He had a consolidated shadow in the right upper lung field, proteinuria with microscopic hematuria, and granulomatous change in the nasal mucosa. The standard regimen of prednisolone alone or in combination with cyclophosphamide showed only a limited effect on the lesion. However, weekly intravenous injections of a high dose of cyclophosphamide (500 mg/week) in combination with 60 mg/day of prednisolone exhibited dramatical suppression of the disease activity.

Multiple Gastric Ulcers in Wegener’s Granulomatosis

“…Uri nalysis showed proteinuria (2.5 g/day); the sediment was loaded with many red blood cells and glass granular casts; serum BUN 60 mg/dl; s-creatinine, 5.9 mg/dl; PSP (15 min), 4%; creatinine clearance, 7.7 ml/min; immunoglobulins were within the normal range. By chest roentgenography, a consoli dated shadow was noted in the right upper field [1], On fiberscopic examination, multiple ul cers, more than three, small and elevated, were observed at the angle or antrum of the stomach. Multiple biopsied specimens from ulcers showed a granulomatous reaction in the mucosa ( fig.…”

“…He was treated with 50 mg/day of pred nisolone and a weekly injection of 500 mg of cyclophosphamide [1 ]. 10 days later, activity of skin lesions was alleviated and his gastric only 9 cases of WG with gastrointestinal in volvement have been reported in the Japa nese literature [4][5][6].…”