Rare Overlap of Granulomatosis With Polyangiitis in a Patient With Rheumatoid Arthritis
Granulomatosis with polyangiitis (GPA) is a systemic small/medium-sized vessel vasculitis, which is a member of the family of antineutrophil cytoplasmic auto-antibody-associated vasculitides. This disorder affects multiple organs as it is a systemic disease, but overlapping with rheumatoid arthritis...
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| Veröffentlicht in: | Curēus (Palo Alto, CA) CA), 2021-11, Vol.13 (11), p.e19303 |
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| creator | Grzybacz, David Udongwo, Ndausung Ashkar, Remi Woodford, Amanda Taj, Sobaan Hossain, Mohammad A Cosentino, James |
| description | Granulomatosis with polyangiitis (GPA) is a systemic small/medium-sized vessel vasculitis, which is a member of the family of antineutrophil cytoplasmic auto-antibody-associated vasculitides. This disorder affects multiple organs as it is a systemic disease, but overlapping with rheumatoid arthritis is extremely rare, with few cases reported in the medical literature. We report a case of a 55-year-old female with a history of rheumatoid arthritis who presented with recurrent upper/lower respiratory tract symptoms that responded poorly to antibiotics. The patient had elevated antiproteinase antibodies, ANCA IgG titer with a cytoplasmic staining pattern, proteinuria, hematuria, chest imaging showing cavitating and non-cavitating masses, and biopsies of lung and nasal tissue confirming the diagnosis of GPA. Our patient was given immunosuppressant therapy and improvement in lab work and clinical symptoms were seen throughout the course of treatment. This case report is unique as GPA usually rarely presents with rheumatoid arthritis (RA), but in this case, the patient had a history of rheumatoid arthritis with a new biopsy-proven GPA. This case report will help future physicians to better diagnose similar cases and help to facilitate clinical recognition and treatment for the same. |
| doi_str_mv | 10.7759/cureus.19303 |
| format | Article |
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This disorder affects multiple organs as it is a systemic disease, but overlapping with rheumatoid arthritis is extremely rare, with few cases reported in the medical literature. We report a case of a 55-year-old female with a history of rheumatoid arthritis who presented with recurrent upper/lower respiratory tract symptoms that responded poorly to antibiotics. The patient had elevated antiproteinase antibodies, ANCA IgG titer with a cytoplasmic staining pattern, proteinuria, hematuria, chest imaging showing cavitating and non-cavitating masses, and biopsies of lung and nasal tissue confirming the diagnosis of GPA. Our patient was given immunosuppressant therapy and improvement in lab work and clinical symptoms were seen throughout the course of treatment. This case report is unique as GPA usually rarely presents with rheumatoid arthritis (RA), but in this case, the patient had a history of rheumatoid arthritis with a new biopsy-proven GPA. This case report will help future physicians to better diagnose similar cases and help to facilitate clinical recognition and treatment for the same.</description><identifier>ISSN: 2168-8184</identifier><identifier>EISSN: 2168-8184</identifier><identifier>DOI: 10.7759/cureus.19303</identifier><identifier>PMID: 34900480</identifier><language>eng</language><publisher>United States: Cureus Inc</publisher><subject>Antibiotics ; Antibodies ; Biopsy ; Blood ; Case reports ; Creatinine ; Granulomas ; Inflammation ; Inflammatory diseases ; Internal Medicine ; Laboratories ; Medical imaging ; Mortality ; Neutrophils ; Nose ; Patients ; Proteins ; Pulmonology ; Rheumatoid arthritis ; Rheumatology ; Stains & staining ; Tomography ; Urinalysis ; Urine ; Vein & artery diseases</subject><ispartof>Curēus (Palo Alto, CA), 2021-11, Vol.13 (11), p.e19303</ispartof><rights>Copyright © 2021, Grzybacz et al.</rights><rights>Copyright © 2021, Grzybacz et al. This work is published under https://creativecommons.org/licenses/by/3.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright © 2021, Grzybacz et al. 2021 Grzybacz et al.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c266t-716879080e5cfc9ff986318404a7e1073603b5773d2f701cda703c0d694bd3163</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8649976/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8649976/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27923,27924,53790,53792</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34900480$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Grzybacz, David</creatorcontrib><creatorcontrib>Udongwo, Ndausung</creatorcontrib><creatorcontrib>Ashkar, Remi</creatorcontrib><creatorcontrib>Woodford, Amanda</creatorcontrib><creatorcontrib>Taj, Sobaan</creatorcontrib><creatorcontrib>Hossain, Mohammad A</creatorcontrib><creatorcontrib>Cosentino, James</creatorcontrib><title>Rare Overlap of Granulomatosis With Polyangiitis in a Patient With Rheumatoid Arthritis</title><title>Curēus (Palo Alto, CA)</title><addtitle>Cureus</addtitle><description>Granulomatosis with polyangiitis (GPA) is a systemic small/medium-sized vessel vasculitis, which is a member of the family of antineutrophil cytoplasmic auto-antibody-associated vasculitides. 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This case report will help future physicians to better diagnose similar cases and help to facilitate clinical recognition and treatment for the same.</description><subject>Antibiotics</subject><subject>Antibodies</subject><subject>Biopsy</subject><subject>Blood</subject><subject>Case reports</subject><subject>Creatinine</subject><subject>Granulomas</subject><subject>Inflammation</subject><subject>Inflammatory diseases</subject><subject>Internal Medicine</subject><subject>Laboratories</subject><subject>Medical imaging</subject><subject>Mortality</subject><subject>Neutrophils</subject><subject>Nose</subject><subject>Patients</subject><subject>Proteins</subject><subject>Pulmonology</subject><subject>Rheumatoid arthritis</subject><subject>Rheumatology</subject><subject>Stains & staining</subject><subject>Tomography</subject><subject>Urinalysis</subject><subject>Urine</subject><subject>Vein & artery diseases</subject><issn>2168-8184</issn><issn>2168-8184</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNpVkc9rwjAYhsPYmOK87TwKu67ua9Pmx2UgsrmBoMiGxxDb1EZq45JW8L9fnE7cKSHfw5uH70XoPoIBpSl_zlqrWjeIOAZ8hbpxRFjIIpZcX9w7qO_cGgAioDFQuEUdnHCAhEEXLebSqmC6U7aS28AUwdjKuq3MRjbGaRcsdFMGM1PtZb3SuvEvug5kMJONVnVzHM9L1R54nQdD25T2gN2hm0JWTvVPZw99vb1-jt7DyXT8MRpOwiwmpAmpl6QcGKg0KzJeFJwR7J0hkVR5X0wAL1NKcR4XFKIslxRwBjnhyTLHEcE99HLM3bbLjcozL2VlJbZWb6TdCyO1-D-pdSlWZicYSTinh4DHU4A1361yjVib1tbeWcQkjj3CUuappyOVWeOcVcX5hwjEoQlxbEL8NuHxh0urM_y3d_wDWJeFsw</recordid><startdate>20211106</startdate><enddate>20211106</enddate><creator>Grzybacz, David</creator><creator>Udongwo, Ndausung</creator><creator>Ashkar, Remi</creator><creator>Woodford, Amanda</creator><creator>Taj, Sobaan</creator><creator>Hossain, Mohammad A</creator><creator>Cosentino, James</creator><general>Cureus Inc</general><general>Cureus</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>5PM</scope></search><sort><creationdate>20211106</creationdate><title>Rare Overlap of Granulomatosis With Polyangiitis in a Patient With Rheumatoid Arthritis</title><author>Grzybacz, David ; 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| subjects | Antibiotics Antibodies Biopsy Blood Case reports Creatinine Granulomas Inflammation Inflammatory diseases Internal Medicine Laboratories Medical imaging Mortality Neutrophils Nose Patients Proteins Pulmonology Rheumatoid arthritis Rheumatology Stains & staining Tomography Urinalysis Urine Vein & artery diseases |
| title | Rare Overlap of Granulomatosis With Polyangiitis in a Patient With Rheumatoid Arthritis |
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