A case of granulomatosis with polyangiitis with severe pansinus osteitis

Abstract

Granulomatosis with polyangiitis (GPA) is an idiopathic systemic vasculitis that often affects the sinuses, and may lead to sinus osteitis, which has generally been described as having a limited distribution. The authors present a rare case of GPA with unusually severe osteitis of all paranasal sinuses, as well as a review of the literature concerning this topic. A female smoker in her late teens presenting with weight loss and epistaxis underwent a lung biopsy confirming the diagnosis of GPA. Otolaryngology evaluation was consistent with chronic rhinosinusitis without nasal polyps (CRSsNP) and GPA. She underwent sinus surgery the year after diagnosis. Two years after initial diagnosis, osteitis was noted in all the paranasal sinuses. She then underwent three more sinus surgeries; subsequent imaging showed progression of the osteitis with obliteration of all paranasal sinuses. This case illustrates an unusually severe case of GPA-associated osteitis which was likely worsened by comorbid CRS and sinus surgery.

Keywords

• Granulomatosis with polyangiitis
• Osteitis
• Chronic rhinosinusitis
• Endoscopic sinus surgery