Head and neck manifestations of granulomatosis with polyangiitis: a retrospective analysis of 19 patients and review of the literature

Introduction: Granulomatosis with Polyangiitis (GPA) is a small vessel vasculitis characterized by a necrositing granulomatous inflammation of the upper and lower respiratory tracts and focal/proliferative glomerulonephritis. In more than 70% of the cases, the presenting symptoms are head and neck manifestations that are often misdiagnosed as infectious or allergic in etiology. Objective: The present study provides an analysis of head and neckmanifestations in a series of patients diagnosed with GPA. It also evaluates their medical and surgical treatment and provides a review of the relevant literature. Methods: A retrospective analysis of 19 patients diagnosed with GPA at a public tertiary care hospital between 2006 and 2017 was performed. Results: A total of 19 patients were included in the present study, and 16 of them presented head and neck manifestations. Sinonasal symptoms were the most common, affecting 56% of the patients, followed by laryngotracheal (31.25%) and ear (25%) symptoms. In 7 patients, sinonasal symptoms were the first manifestation of the disease (43.75%). Four patients underwent surgery at some stage of the disease. Conclusions: Head and neck involvement is common in GPA and may stand for the first or the onlymanifestation of the disease. The otolaryngologists play a central role in the diagnosis and long-term treatment of these patients, and they have to keep this pathology in mind when treating patients with ENT symptoms that do not respond as expected to the treatment (AU)

Holmium Laser for Endoscopic Treatment of Benign Tracheal Stenosis

Abstract Introduction Laryngotracheal stenosis is a difficult problem with varied etiology and various treatment options. The holmium laser represents another tool for the treatment of benign tracheal stenosis. Objectives To determine the utility of holmium laser treatment for benign tracheal stenosis with regards to safety and efficacy. Methods This was a retrospective case study examining patients with benign tracheal stenosis from 1998-2016 who underwent holmium laser treatment. Determining the safety of this procedure was the primary goal, and complications were monitored as a surrogate of safety. Results A total of 123 patients who underwent holmium laser treatment for benign tracheal stenosis were identified. In total, 123 patients underwent 476 procedures, with follow-up ranging from 1 month to 14 years. No intraoperative or post-operative complications were identified as a direct result of the use of this particular laser. Conclusions The holmium laser is an effective and safe laser to use for tracheal stenosis treatment. It is a contact laser with a short acting distance, which reduces the risk of injury to distal airway structures. Given the favorable experience reported here, the holmium laser should be considered when tracheal surgery is attempted.

Rinosinusitis recalcitrante por granulomatosis eosinofílica con poliangeítis: reporte de un caso clínico y revisión de la literatura / Chronic recalcitrant rhinosinusitis secondary to eosinophilic granulomatosis with polyangiitis: report of a case and literature review

RESUMEN Se expone el caso de un paciente de 40 años con diagnóstico de granulomatosis eosinofílica con poliangeítis subyacente a una rinosinusitis crónica recalcitrante. Se describe el caso y se discuten aspectos relevantes de la literatura al respecto.

ABSTRACT We report the case of a 40-year-old man with diagnosis of chronic recalcitrant rhino-sinusitis secondary to eosinophilic granulomatosis with polyangiitis. We described the case and discuss relevant aspects of the literature about it.

Granulomatosis de Wegener / Wegener's granulomatosis

Se presenta un caso de granulomatosis de Wegener (GW) en una paciente de 56 años cuya sintomatología inicial y única fue a nivel de oídos. Las manifestaciones otológicas incluían otitis serosa refractaria que progresó a una mastoiditis subaguda unilateral y parálisis facial progresiva. La radiografía de tórax mostró infiltrados nodulares. Se le practicó un vaciamiento mastoídeo bilateral simultáneo y una descompresión del nervio facial derecho. El diagnóstico de GW se hizo basado en los hallazgos histológicos del tejido granulatorio obtenido de ambas mastoides y confirmado por los anticuerpos anticitoplasma de neutrófilos (ANCA). El tratamiento se basó en el uso prolongado de ciclofosfamida oral asociado a esteroides. Se realiza una revisión bibliográfica del tema, enfatizando que el veinte por ciento de los pacientes con GW tendrán alguna manifestación otológica durante su enfermedad. En algunos casos los síntomas de oído serán los síntomas iniciales de la enfermedad. La no respuesta al tratamiento convencional será lo que nos deba llevar a la sospecha diagnóstica. La confirmación diagnóstica se hace por medio de los ANCA, los cuales también son útiles en el seguimiento de la enfermedad, tanto para evaluar el resultado del tratamiento como para ver la actividad a largo plazo de la enfermedad