Rhinosinusitis Associated with ANCA-Associated Vasculitis

A patient with ANCA-associated vasculitis may develop rhinosinusitis.

ANCA-associated vasculitis with rhinosinusitis:

(1) Wegener's granulomatosis (granulomatosis with polyangiitis)

(2) Churg-Strauss syndrome (eosinophilic granulomatosis with polyangiitis)

(3) microscopic polyangiitis (MPA)

Features suggesting vasculitis-associated rhinosinusitis:

(1) ulcerations and/or destructive lesions

(2) involvement in other organs (kidneys, lungs, etc)

(3) vasculitis and/or granulomatous inflammation on biopsy

(4) ANCA positive (anti-PR3 c-ANCA with Wegener's, anti-MPO p-ANCA with Churg-Strauss and MPA)

(5) failure to respond to routine therapy

Finding	WG	CSS	MPA
rhinitis, non-erosive	x	x	x
rhinitis, erosive	x
sinusitis, non-erosive	x	x	x
sinusitis, erosive	x
sinusitis, atrophic	x
nasal polyps		x
epistaxis and crusting	x	x
anosmia or hypoosmia	x	x
nasal septum destruction with perforation or saddle nose	x

Differential diagnosis:

(1) infectious diseases (tuberculosis, deep fungal infections, syphilis, etc)

(2) cocaine or other forms of drug abuse

(3) repetitive trauma

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