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
Specialty: Otolaryngology, Infectious Diseases, Immunology/Rheumatology
ICD-10: ,