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Conjunctivitis, episcleritis and anterior uveitis as the first presenting features of granulomatosis with polyangiitis
  1. Lucas Donato Foster1,
  2. Michael Nyugen2 and
  3. Edward Margolin2
  1. 1Department of Medicine, University of Western Ontario, London, Ontario, Canada
  2. 2Department of Ophthalmology and Vision Science, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
  1. Correspondence to Lucas Donato Foster; lfoste9{at}uwo.ca

Abstract

Granulomatosis with polyangiitis (GPA) is a rare disorder characterised by inflammation of small-sized and medium-sized blood vessels that result in damage to various organ systems, but it most commonly affects the respiratory tract and kidneys. It is one of the few entities that can present with ocular inflammation as well as renal impairment at the same time. We describe a case of a 38-year-old man with conjunctivitis, episcleritis, anterior uveitis as a first manifestation of GPA. His presentation with red eye and anterior uveitis prompted further workup, which revealed acute renal failure (creatinine 442 mmol/L), elevated inflammatory markers (erythrocyte sedimentation rate of 85 mmol/hour and C reactive protein of 72 mg/L), and a c-antineutrophil cytoplasmic antibody titre >8. An urgent renal biopsy was performed demonstrating necrotising crescentic glomerulonephritis, which led to the final diagnosis of GPA. Treatment induction with intravenous methylprednisolone and plasmapheresis followed by an oral prednisone taper and intravenous rituximab infusions leading to resolution of all symptoms and normalisation of kidney function. This report highlights conditions that can present with both ocular inflammation and renal dysfunction with a focus on GPA and its ocular manifestations.

  • anterior chamber
  • vasculitis

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Footnotes

  • Contributors LDF wrote the background, discussion, drafted and revised the paper. He is guarantor. MN wrote the summary, case presentation, investigations, differential diagnosis and treatment. EM oversaw and conceptualised the project, wrote the learning points and revised the draft paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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