Granulomatosis with polyangiitis - Revision history

Rossdonaldson1: /* Evaluation */

2024-04-24T17:52:47Z

Evaluation

← Revisión anterior		Revisión del 17:52 24 abr 2024
Línea 27:		Línea 27:

	==Evaluation==		==Evaluation==
	[[File:Wegener's Granulomatosis - X-ray Case 190 (5958079204).jpg\|thumb\|Bilateral upper lobe nodular lesions~~. Pt. presented~~ with hemoptysis.]]		[[File:Wegener's Granulomatosis - X-ray Case 190 (5958079204).jpg\|thumb\|Bilateral upper lobe nodular lesions in a patient with Granulomatosis with polyangiitis presenting with hemoptysis.]]
	===Workup===		===Workup===
	*Definitive diagnosis: Biopsy		*Definitive diagnosis: Biopsy

Rossdonaldson1: /* Evaluation */

2024-04-24T17:52:12Z

Evaluation

← Revisión anterior		Revisión del 17:52 24 abr 2024
Línea 28:		Línea 28:
	==Evaluation==		==Evaluation==
	[[File:Wegener's Granulomatosis - X-ray Case 190 (5958079204).jpg\|thumb\|Bilateral upper lobe nodular lesions. Pt. presented with hemoptysis.]]		[[File:Wegener's Granulomatosis - X-ray Case 190 (5958079204).jpg\|thumb\|Bilateral upper lobe nodular lesions. Pt. presented with hemoptysis.]]
	~~===Classification===~~
	*American College of Rheumatology: 88% sensitivity and 92% specificity for ≥2 criteria
	*Nasal or oral inflammation
	*Abnormal chest radiograph showing nodules, fixed infiltrate, or cavities
	*Abnormal urinary sedimentation (microscopic hematuria)
	*Granulomatous inflammation on biopsy of an artery or perivascular area
	===Workup===		===Workup===
	*Definitive diagnosis: Biopsy		*Definitive diagnosis: Biopsy
Línea 45:		Línea 39:
	*Consider ANA, C3 or C4, cryoglobulins, [[viral hepatitis\|hepatitis serology]], HIV, [[LFTs]], blood culture to rule out other pathology		*Consider ANA, C3 or C4, cryoglobulins, [[viral hepatitis\|hepatitis serology]], HIV, [[LFTs]], blood culture to rule out other pathology
	*Other tests: Bronchoscopy, PFT, sinus CT		*Other tests: Bronchoscopy, PFT, sinus CT

			===Classification===
			*American College of Rheumatology: 88% sensitivity and 92% specificity for ≥2 criteria
			*Nasal or oral inflammation
			*Abnormal chest radiograph showing nodules, fixed infiltrate, or cavities
			*Abnormal urinary sedimentation (microscopic hematuria)
			*Granulomatous inflammation on biopsy of an artery or perivascular area

	==Management==		==Management==

Rossdonaldson1: /* Evaluation */

2024-04-24T17:51:48Z

Evaluation

← Revisión anterior		Revisión del 17:51 24 abr 2024
Línea 27:		Línea 27:

	==Evaluation==		==Evaluation==
			[[File:Wegener's Granulomatosis - X-ray Case 190 (5958079204).jpg\|thumb\|Bilateral upper lobe nodular lesions. Pt. presented with hemoptysis.]]
	===Classification===		===Classification===
	*American College of Rheumatology: 88% sensitivity and 92% specificity for ≥2 criteria		*American College of Rheumatology: 88% sensitivity and 92% specificity for ≥2 criteria

Rossdonaldson1: /* Background */

2023-08-02T17:43:49Z

Background

← Revisión anterior		Revisión del 17:43 2 ago 2023
Línea 4:		Línea 4:
	*Small- and medium-sized blood vessels		*Small- and medium-sized blood vessels
	*Predilection for upper and lower respiratory tracts and kidneys		*Predilection for upper and lower respiratory tracts and kidneys

			{{Primary Vasculitis DDX}}

	==Clinical Features==		==Clinical Features==

ClaireLewis: /* Workup */

2019-10-16T17:36:39Z

Workup

← Revisión anterior		Revisión del 17:36 16 oct 2019
Línea 37:		Línea 37:
	*ESR/CRP elevated		*ESR/CRP elevated
	*BUN/Cr		*BUN/Cr
	*[[Urinalysis]] (hematuria, proteinuria)		*[[Urinalysis]] ([[hematuria]], [[proteinuria]])
	*[[CXR]]- Pulmonary infiltrates and nodules		*[[CXR]]- Pulmonary infiltrates and nodules
	*CT chest		*CT chest
	*~~To consider~~ ANA, C3 or C4, cryoglobulins, [[viral hepatitis\|hepatitis serology]], HIV, [[LFTs]], blood culture to rule out other pathology		*Consider ANA, C3 or C4, cryoglobulins, [[viral hepatitis\|hepatitis serology]], HIV, [[LFTs]], blood culture to rule out other pathology
	*Other tests: Bronchoscopy, PFT, sinus CT		*Other tests: Bronchoscopy, PFT, sinus CT

ClaireLewis at 16:43, 16 October 2019

2019-10-16T16:43:24Z

← Revisión anterior		Revisión del 16:43 16 oct 2019
Línea 9:		Línea 9:
	*White, older patients		*White, older patients
	*Constitutional symptoms: [[Fever]], malaise, weight loss		*Constitutional symptoms: [[Fever]], malaise, weight loss
	*Upper airway: Serous [[otitis media]], hearing loss, [[sinusitis]], nasal mucosal ulcerations, septal perforation, [[epistaxis]], laryngotracheal disease		*Upper airway: Serous [[otitis media]], [[hearing loss]], [[sinusitis]], nasal mucosal ulcerations, septal perforation, [[epistaxis]], laryngotracheal disease
	**Subglottic stenosis is most common laryngotracheal lesion (16% patients)		**[[Subglottic stenosis]] is most common laryngotracheal lesion (16% patients)
	*Lower respiratory: [[Cough]], [[dyspnea]], pleuritis, [[hemoptysis]], [[diffuse alveolar hemorrhage]]		*Lower respiratory: [[Cough]], [[dyspnea]], pleuritis, [[hemoptysis]], [[diffuse alveolar hemorrhage]]
	*[[Renal failure]], [[glomerulonephritis]]		*[[Renal failure]], [[glomerulonephritis]]
	*Ophthalmologic: [[scleritis]], [[episcleritis]], [[uveitis]]		*Ophthalmologic: [[scleritis]], [[episcleritis]], [[uveitis]]
	*Cutaneous: Palpable [[purpura]], nodules, ulcers		*Cutaneous: Palpable [[purpura]], nodules, ulcers
	*Neurologic: Mononeuropathy and polyneuropathy, cerebral vasculitis, cerebral hemorrhage or thrombosis		*Neurologic: Mononeuropathy and polyneuropathy, cerebral vasculitis, [[ICH\|cerebral hemorrhage]] or [[cerebral venous thrombosis\|thrombosis]]
	*Cardiac: [[Pericarditis]], [[myocarditis]]		*Cardiac: [[Pericarditis]], [[myocarditis]]

Línea 34:		Línea 34:
	*Definitive diagnosis: Biopsy		*Definitive diagnosis: Biopsy
	*ANCA +, RF+		*ANCA +, RF+
	*CBC: Leukocytosis, normochromic anemia, thrombocytosis		*CBC: [[Leukocytosis]], normochromic [[anemia]], [[thrombocytosis]]
	*ESR/CRP elevated		*ESR/CRP elevated
	*BUN/Cr		*BUN/Cr
Línea 40:		Línea 40:
	*[[CXR]]- Pulmonary infiltrates and nodules		*[[CXR]]- Pulmonary infiltrates and nodules
	*CT chest		*CT chest
	*To consider ANA, C3 or C4, cryoglobulins, hepatitis serology, HIV, ~~LFT~~, blood culture to rule out other pathology		*To consider ANA, C3 or C4, cryoglobulins, [[viral hepatitis\|hepatitis serology]], HIV, [[LFTs]], blood culture to rule out other pathology
	*Other tests: Bronchoscopy, PFT, sinus CT		*Other tests: Bronchoscopy, PFT, sinus CT

	==Management==		==Management==
	*Priority: Manage pulmonary hemorrhage and renal insufficiency		*Priority: Manage pulmonary hemorrhage and renal insufficiency
	**[[Difficult airway]]: Diffuse alveolar hemorrhage and subglottic stenosis		**[[Difficult airway]]: [[Diffuse alveolar hemorrhage]] and [[subglottic stenosis]]
	***Fiberoptic intubation through LMA advocated		***Fiberoptic intubation through LMA advocated
	*Rheumatology consult + multidisciplinary consults		*Rheumatology consult + multidisciplinary consults
	*Mild disease: [[Corticosteroids]] and [[methotrexate]]		*Mild disease: [[Corticosteroids]] and [[methotrexate]]
	**No active glomerulonephritis or organ-threatening disease		**No active glomerulonephritis or organ-threatening disease
	*Mod-Severe disease: Corticosteroids and [[cyclophosphamide]] or [[rituximab]]		*Mod-Severe disease: [[Corticosteroids]] and [[cyclophosphamide]] or [[rituximab]]
	*Corticosteroids:		*[[Corticosteroids]]:
	**[[Methylprednisolone]] (7-15mg/kg/d with max 1000mg)		**[[Methylprednisolone]] (7-15mg/kg/d with max 1000mg)
	**[[Prednisone]] 1mg/kg/d (max 80mg)		**[[Prednisone]] 1mg/kg/d (max 80mg)

ClaireLewis at 22:55, 13 November 2016

2016-11-13T22:55:18Z

← Revisión anterior		Revisión del 22:55 13 nov 2016
Línea 1:		Línea 1:
	==Background==		==Background==
	*Formerly known as ''Wegener's granulomatosis''		*Formerly known as ''Wegener's granulomatosis''
	*c-ANCA associated systemic necrotizing vasculitis		*c-ANCA associated systemic necrotizing [[vasculitis]]
	*Small- and medium-sized blood vessels		*Small- and medium-sized blood vessels
	*Predilection for upper and lower respiratory tracts and kidneys		*Predilection for upper and lower respiratory tracts and kidneys
Línea 8:		Línea 8:
	*Upper respiratory, pulmonary and renal disease + constitutional symptoms		*Upper respiratory, pulmonary and renal disease + constitutional symptoms
	*White, older patients		*White, older patients
	*Constitutional symptoms: Fever, malaise, weight loss		*Constitutional symptoms: [[Fever]], malaise, weight loss
	*Upper airway: Serous ~~otits~~ media, hearing loss, sinusitis, nasal mucosal ulcerations, septal perforation, epistaxis, laryngotracheal disease		*Upper airway: Serous [[otitis media]], hearing loss, [[sinusitis]], nasal mucosal ulcerations, septal perforation, [[epistaxis]], laryngotracheal disease
	**Subglottic stenosis MC laryngotracheal lesion (16% patients)		**Subglottic stenosis is most common laryngotracheal lesion (16% patients)
	*Lower respiratory: Cough, dyspnea, pleuritis, hemoptysis, diffuse alveolar hemorrhage		*Lower respiratory: [[Cough]], [[dyspnea]], pleuritis, [[hemoptysis]], [[diffuse alveolar hemorrhage]]
	*Renal failure, glomerulonephritis		*[[Renal failure]], [[glomerulonephritis]]
	*Ophthalmologic: scleritis, episcleritis, uveitis		*Ophthalmologic: [[scleritis]], [[episcleritis]], [[uveitis]]
	*Cutaneous: Palpable purpura, nodules, ulcers		*Cutaneous: Palpable [[purpura]], nodules, ulcers
	*Neurologic: Mononeuropathy and polyneuropathy, cerebral vasculitis, cerebral hemorrhage or thrombosis		*Neurologic: Mononeuropathy and polyneuropathy, cerebral vasculitis, cerebral hemorrhage or thrombosis
	*Cardiac: Pericarditis, myocarditis		*Cardiac: [[Pericarditis]], [[myocarditis]]

	==Differential Diagnosis==		==Differential Diagnosis==
	*[[Polyarteritis nodosa]], [[Churg-Strauss syndrome]], [[SLE]], [[Goodpasture syndrome]]		*[[Polyarteritis nodosa]], [[Eosinophilic granulomatosis with polyangiitis]] (Churg-Strauss syndrome), [[SLE]], [[Goodpasture syndrome]]
	*Lymphoma, lung cancer		*[[Lymphoma]], lung cancer
	*[[~~Pnuemonia~~]], infective [[endocarditis]], [[HUS]]		*[[Pneumonia]], infective [[endocarditis]], [[HUS]]
	*[[Glomerulonephritis]]		*[[Glomerulonephritis]]

Línea 34:		Línea 34:
	*Definitive diagnosis: Biopsy		*Definitive diagnosis: Biopsy
	*ANCA +, RF+		*ANCA +, RF+
	*CBC: Leukocytosis, ~~normochronic~~ anemia, thrombocytosis		*CBC: Leukocytosis, normochromic anemia, thrombocytosis
	*ESR/CRP elevated		*ESR/CRP elevated
	*BUN/Cr		*BUN/Cr
Línea 45:		Línea 45:
	==Management==		==Management==
	*Priority: Manage pulmonary hemorrhage and renal insufficiency		*Priority: Manage pulmonary hemorrhage and renal insufficiency
	**Difficult airway: Diffuse alveolar hemorrhage and subglottic stenosis		**[[Difficult airway]]: Diffuse alveolar hemorrhage and subglottic stenosis
	***Fiberoptic intubation through LMA advocated		***Fiberoptic intubation through LMA advocated
	*Rheumatology consult + multidisciplinary consults		*Rheumatology consult + multidisciplinary consults
	*Mild disease: Corticosteroids and methotrexate		*Mild disease: [[Corticosteroids]] and [[methotrexate]]
	**No active glomerulonephritis or organ-threatening disease		**No active glomerulonephritis or organ-threatening disease
	*Mod-Severe disease: Corticosteroids and cyclophosphamide or rituximab		*Mod-Severe disease: Corticosteroids and [[cyclophosphamide]] or [[rituximab]]
	*Corticosteroids:		*Corticosteroids:
	**Methylprednisolone (7-15mg/kg/d with max 1000mg)		**[[Methylprednisolone]] (7-15mg/kg/d with max 1000mg)
	**Prednisone 1mg/kg/d (max 80mg)		**[[Prednisone]] 1mg/kg/d (max 80mg)
	*Methotrexate: 20-25mg weekly PO or SC		*[[Methotrexate]]: 20-25mg weekly PO or SC
	*Cyclophosphamide: 2mg/kg/d PO or 15mg/kg q2 weeks x3 then q3 weeks		*[[Cyclophosphamide]]: 2mg/kg/d PO or 15mg/kg q2 weeks x3 then q3 weeks
	*Rituximab: 357mg/m² weekly x 4		*[[Rituximab]]: 357mg/m² weekly x 4
	*To consider plasma exchange: Severe/rapidly progressive renal disease, concurrent anti-GBM Ab disease, severe pulmonary hemorrhage		*To consider [[plasma exchange]]: Severe/rapidly progressive renal disease, concurrent anti-GBM Ab disease, severe pulmonary hemorrhage

	==Disposition==		==Disposition==

Rossdonaldson1: Text replacement - "UA" to "Urinalysis"

2016-10-02T17:00:05Z

Text replacement - "*UA" to "*Urinalysis"

← Revisión anterior		Revisión del 17:00 2 oct 2016
Línea 37:		Línea 37:
	*ESR/CRP elevated		*ESR/CRP elevated
	*BUN/Cr		*BUN/Cr
	*UA (hematuria, proteinuria)		*[[Urinalysis]] (hematuria, proteinuria)
	*[[CXR]]- Pulmonary infiltrates and nodules		*[[CXR]]- Pulmonary infiltrates and nodules
	*CT chest		*CT chest

Rossdonaldson1: Text replacement - "CXR" to "CXR"

2016-09-09T14:27:11Z

Text replacement - "*CXR" to "*CXR"

← Revisión anterior		Revisión del 14:27 9 sep 2016
Línea 38:		Línea 38:
	*BUN/Cr		*BUN/Cr
	*UA (hematuria, proteinuria)		*UA (hematuria, proteinuria)
	*CXR- Pulmonary infiltrates and nodules		*[[CXR]]- Pulmonary infiltrates and nodules
	*CT chest		*CT chest
	*To consider ANA, C3 or C4, cryoglobulins, hepatitis serology, HIV, LFT, blood culture to rule out other pathology		*To consider ANA, C3 or C4, cryoglobulins, hepatitis serology, HIV, LFT, blood culture to rule out other pathology

Rossdonaldson1: Text replacement - "r/o" to "rule out"

2016-07-30T13:26:31Z

Text replacement - "r/o" to "rule out"

← Revisión anterior		Revisión del 13:26 30 jul 2016
Línea 40:		Línea 40:
	*CXR- Pulmonary infiltrates and nodules		*CXR- Pulmonary infiltrates and nodules
	*CT chest		*CT chest
	*To consider ANA, C3 or C4, cryoglobulins, hepatitis serology, HIV, LFT, blood culture to ~~r/o~~ other pathology		*To consider ANA, C3 or C4, cryoglobulins, hepatitis serology, HIV, LFT, blood culture to rule out other pathology
	*Other tests: Bronchoscopy, PFT, sinus CT		*Other tests: Bronchoscopy, PFT, sinus CT

Granulomatosis with polyangiitis - Revision history

Rossdonaldson1: /* Evaluation */

Rossdonaldson1: /* Evaluation */

Rossdonaldson1: /* Evaluation */

Rossdonaldson1: /* Background */

ClaireLewis: /* Workup */

ClaireLewis at 16:43, 16 October 2019

ClaireLewis at 22:55, 13 November 2016

Rossdonaldson1: Text replacement - "*UA" to "*Urinalysis"

Rossdonaldson1: Text replacement - "*CXR" to "*CXR"

Rossdonaldson1: Text replacement - "r/o" to "rule out"

Rossdonaldson1: Text replacement - "UA" to "Urinalysis"

Rossdonaldson1: Text replacement - "CXR" to "CXR"