RELAPSING GRANULOMATOSIS WITH POLYANGITIS COMPLICATED BY CHRONIC KIDNEY DISEASE AND OPPORTUNISTIC INFECTIONS
Rimisha Thomas*, Anna Davice, Rony Rose George and Jobin Kunjumon Vilapurathu
Granulomatosis with polyangitis is an uncommon, multisystem autoimmune disorder with an as yet undetermined incidence. Renal manifestations are a characteristic feature of this necrotizing vasculitis and largely determine the prognosis of the disease. Frequent relapses necessitate the need for maintenance treatment using immunosuppressants and corticosteroids, the cumulative doses which can in turn precipitate opportunistic infections. We herein report a relapse case of granulomatosis with polyangitis in a 57 year old male patient who presented with fever, cough, blood tinged sputum and polyarthralgia. Clinical,radiological and histo-pathological assessments revealed granulomatosis with polyangitis complicated by significant renal impairment and opportunistic infections, namely pneumonia and candidiasis. Rapid remission was attained using a combination of prednisone and rituximab.With intensified antibiosis and symptomatic therapy, the patient recovered and was discharged on the 14th day post admission. This report illustrates the importance of early diagnosis and a multi-modal approach in attaining remission and preventing the late complications of this rare disorder.
Keywords: Granulomatosis with polyangitis, Wegener's granulomatosis, crescentic glomerulonephritis, opportunistic infections.
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