A 41-year-old woman presented to her primary doctor with nausea, back pain and lower extremity oedema. Initial labs showed elevated serum creatinine and white blood cell count (WBC), which her doctor attributed to ibuprofen use and a recent upper respiratory infection. Five days later, she presented to the eye clinic with eye pain, redness and blurred vision. She was diagnosed with iritis, conjunctivitis and keratitis. The inflammatory eye disease with decreased renal function prompted the ophthalmologist to initiate systemic autoimmune and infectious disease work-up. Before laboratory testing was complete, she developed severe haemoptysis. Diagnosis of granulomatosis with polyangiitis (GPA) was confirmed using blood testing, radiological imaging and kidney biopsy. She received plasmapheresis, then cyclophosphamide and prednisone with good effect. This case highlights the need to consider GPA in the differential when patients present with inflammatory eye disease with decreased renal function and the need for multispecialty collaboration including ophthalmologists in the diagnosis of GPA.
- Acute renal failure
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Contributors SPP, CIT and LAM contributed to the conception, data collection and data interpretation of this case report. SPP, CIT and MJB drafted the manuscript. SPP and MJB were involved in critical revision of the manuscript. All authors approved of the final version for publication.
Funding This work was funded inpart by an unrestricted grant to the Department of Ophthalmology, SUNY-University at Buffalo, from Research to Prevent Blindness, New York, NY.
Disclaimer The opinions expressed herein do not necessarily represent those of the Veterans Administration or the US government.
Competing interests SPP is a consultant to Novartis for expertise unrelated to the topic of this manuscript.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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