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Internal Medicine logoLink to Internal Medicine
. 2019 May 22;58(17):2587–2588. doi: 10.2169/internalmedicine.2903-19

Juxta-vertebral Lesions Associated with Granulomatosis with Polyangiitis

Yumi Yoshida 1, Shinjiro Kaieda 1, Takuya Furuta 2, Hiroaki Ida 1
PMCID: PMC6761342  PMID: 31118406

A 73-year-old woman was referred to our hospital for a fever, hoarseness, and progressive renal failure. A renal biopsy showed necrotizing extracapillary pauci-immune glomerulonephritis. A laryngoscopic examination revealed inflammation of the vocal cords. Myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) levels were elevated. The patient met the Japanese criteria for the diagnosis of granulomatosis with polyangiitis (GPA). She was treated with high-dose steroids and cyclophosphamide, which resulted in amelioration of the clinical symptoms and improvement of the renal function. Glucocorticoid therapy was gradually tapered, and she developed a fever and back pain with another increase in the MPO-ANCA and C-reactive protein (CRP) levels. Chest computed tomography demonstrated juxta-vertebral lesions that were 18-fluorodeoxyglucose positron emission tomography-positive (Picture A and B, arrows). A histological examination of the juxta-vertebral lesions showed nonspecific signs of inflammation and malignancy, and infectious diseases were ruled out (Picture C). Rituximab therapy improved the juxta-vertebral lesions and reduced the MPO-ANCA and CRP levels (Picture D). Juxta-vertebral lesions associated with GPA have rarely been reported (1,2).

Picture.

Picture.

The authors state that they have no Conflict of Interest (COI).

References

  • 1. Ramirez GA, Della-Torre E, Campochiaro C, et al. Juxta-vertebral lesions in granulomatosis with polyangiitis. Semin Arthritis Rheum 46: 356-360, 2016. [DOI] [PubMed] [Google Scholar]
  • 2. Barreto P, Pagnoux C, Luca L, et al. Dorsal prevertebral lesions in Wegener granulomatosis: report on four cases. Joint Bone Spine 78: 88-91, 2011. [DOI] [PubMed] [Google Scholar]

Articles from Internal Medicine are provided here courtesy of Japanese Society of Internal Medicine

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