Localised presentation of granulomatosis with polyangiitis: The great masquerade

      A 30-year-old male presented with a history of persistent nasal obstruction for 2 years. There was an associated history of occasional blood-stained discharge. The patient also complained of occasional ear ache and blocked sensation in both the ears without any ear discharge. There was no history of fever or weight loss. Aural examination revealed serous otitis media on both sides. Nasal endoscopy revealed mucopus and crusts in the nasal cavity with congested and granular turbinates. There was a septal perforation in the cartilaginous septum and the edges of the perforation were granular (Fig. 1A) . Nasal biopsy taken from the inferior turbinate revealed a mixed inflammatory infiltrate along with leucocytoclastic vasculitis of the medium and small vessels with hematoxyline & eosin staining (Fig. 1B, 40x magnification). The cANCA levels for the patient was positive and the Proteinase (PR3) antibody levels were 60 EU/mL (normal <10 EU/mL). Evaluation of the renal function was unremarkable. HRCT of the chest revealed a small nodule in the left middle lobe.
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