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Granulomatosis with Polyangiitis (GPA) in a 15-year-old Girl with Facial Acne-like Ulcers: A Case Report

Author(s):

Saeed Reza Jamali Moghadam, Mohammad Reza Salehi, Seyed Yousef Mojtahedi, Narges Fadaei, Omid Dadras, Seyed Ahmad Seyed Alinaghi* and Mona Mohammadifirouzeh   Pages 1 - 5 ( 5 )

Abstract:


Granulomatosis with polyangiitis (GPA), formerly known as Wegener's granulomatosis (WG), is a multisystem autoimmune disease of unknown etiology often misdiagnosed as pneumonia. The hallmark features include necrotizing granulomatous inflammation and pauci-immune vasculitis in small and medium-size blood vessels. We described a 15-year-old female with a history of six months of acne-like facial and peri-auricular lesions. She had received the conventional treatment for acne (antibiotics + topical corticosteroid) with no response. She also had a history of chronic coughs which always diagnosed and treated as sinusitis. In addition, she had a history of frequent dysuria which always diagnosed and treated as urinary tract infection. Given the history, with suspicion of a multi-systemic disease such as vasculitis; we performed some diagnostic laboratory and radiologic tests in order to rule out the possible etiologies. The results showed positive for cytoplasmic anti-neutrophil cytoplasmic antibody (C-ANCA). The urine analysis suggested the involvement of kidney micro-vasculature. In addition, two nodular lesions with cystic pattern were observed in lungs CT scan. However, the skin and nasal biopsies revealed no evidence of chronic necrotizing vasculitis or granulomatous lesion. Nonetheless, treatment was initiated with a strong suspicion of GPA. Following the treatment, the patient's symptoms completely disappeared, and the diagnosis of GPA was confirmed.

Keywords:

Granulomatosis with polyangiitis (GPA), Acne, Wegener

Affiliation:

Ziaeian Hospital, Tehran University of Medical Sciences, Tehran, Department of Infectious Diseases and Tropical Medicine, Tehran University of Medical Sciences, Tehran, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Department of Family Medicine, Medicine Faculty, Tehran University of Medical Sciences, Tehran, Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, George Mason University, School of Nursing, 4400 University Dr, Fairfax,VA 22030



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