Granulomatosis with polyangiitis physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Ali Poyan Mehr, M.D. [2]Associate Editor(s)-in-Chief: Amandeep Singh M.D.[3]Krzysztof Wierzbicki M.D. [4]

Overview

The important physical exam findings are Ulcerations, palpable purpura and subcutaneous nodules in the skin; conjunctivitis, uveitis, sinusitis, purulent exudate from nares,saddle nose deformity, reduced hearing in the head and neck; pleuritic chest pain ans signs of atelectasis in lung examination; and signs of mononeuritis multiplex on neural exam.

Physical Examination

  • Physical examination of patients with Granulomatosis with polyangiitis is usually remarkable for:[1][2]

Vital Signs

  • They usually have normal vital signs until infected.

Skin

The skin findings are seen in 14% of patients:[3]

HEENT

Neck

  • Neck examination of patients with granulomatosis with polyangiitis is usually normal.

Lungs

Examination may show signs of:

Heart

Abdomen

Back

  • Back examination of patients with granulomatosis with polyangiitis is usually normal.

Genitourinary

  • A pelvic/adnexal mass may be palpated
  • Inflamed mucosa

Neuromuscular

  • Patient is usually oriented to persons, place, and time
  • Mononeuritis multiplex[7]- Loss of sensory and motor functions
  • Cranial nerve paralysis

Extremities

  • Extremities examination of patients with granulomatosis with polyangiitis is usually normal.

References

  1. 1.0 1.1 Seo P, Stone JH (July 2004). "The antineutrophil cytoplasmic antibody-associated vasculitides". Am. J. Med. 117 (1): 39–50. doi:10.1016/j.amjmed.2004.02.030. PMID 15210387.
  2. Graves N (October 2006). "Wegener granulomatosis". Proc (Bayl Univ Med Cent). 19 (4): 342–4. PMC 1618758. PMID 17106496.
  3. Daoud MS, Gibson LE, DeRemee RA, Specks U, el-Azhary RA, Su WP (October 1994). "Cutaneous Wegener's granulomatosis: clinical, histopathologic, and immunopathologic features of thirty patients". J. Am. Acad. Dermatol. 31 (4): 605–12. PMID 8089286.
  4. Cannady SB, Batra PS, Koening C, Lorenz RR, Citardi MJ, Langford C, Hoffman GS (April 2009). "Sinonasal Wegener granulomatosis: a single-institution experience with 120 cases". Laryngoscope. 119 (4): 757–61. doi:10.1002/lary.20161. PMID 19263410.
  5. Genuis K, Pewarchuk J (September 2014). "Granulomatosis with polyangiitis (Wegener's) as a necrotizing gingivitis mimic: a case report". J Med Case Rep. 8: 297. doi:10.1186/1752-1947-8-297. PMC 4168997. PMID 25196320.
  6. Pagnoux C, Mahr A, Cohen P, Guillevin L (March 2005). "Presentation and outcome of gastrointestinal involvement in systemic necrotizing vasculitides: analysis of 62 patients with polyarteritis nodosa, microscopic polyangiitis, Wegener granulomatosis, Churg-Strauss syndrome, or rheumatoid arthritis-associated vasculitis". Medicine (Baltimore). 84 (2): 115–28. PMID 15758841.
  7. Anadure R, Narayanan C, Varadraj G, Nandeesh B (January 2017). "ANCA Associated Mononeuritis Multiplex with Overlap in Vasculitic Syndromes". J Clin Diagn Res. 11 (1): OD01–OD03. doi:10.7860/JCDR/2017/22252.9149. PMC 5324437. PMID 28273992.