A case of granulomatosis with polyangiitis (Wegener's granulomatosis) manifested with asymptomatic intracerebral hemorrhage

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  • TAKAOKA Hirokazu
    Department of Rheumatology, Sagamihara National Hospital, National Hospital Organization
  • HASHIMOTO Atsushi
    Department of Rheumatology, Sagamihara National Hospital, National Hospital Organization
  • NOGI Shinichi
    Department of Rheumatology, Sagamihara National Hospital, National Hospital Organization
  • IWATA Kanako
    Department of Rheumatology, Sagamihara National Hospital, National Hospital Organization
  • FUTAMI Hidekazu
    Department of Rheumatology, Sagamihara National Hospital, National Hospital Organization
  • ARINUMA Yoshiyuki
    Department of Rheumatology, Sagamihara National Hospital, National Hospital Organization
  • SHIMADA Kota
    Department of Rheumatology, Sagamihara National Hospital, National Hospital Organization
  • NAKAYAMA Hisanori
    Department of Rheumatology, Sagamihara National Hospital, National Hospital Organization
  • KOMIYA Akiko
    Department of Rheumatology, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, National Hospital Organization
  • FURUKAWA Hiroshi
    Department of Rheumatology, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, National Hospital Organization
  • MATSUI Toshihiro
    Department of Rheumatology, Sagamihara National Hospital, National Hospital Organization
  • TOHMA Shigeto
    Department of Rheumatology, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, National Hospital Organization

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  A 46-year-old man, who had had sinusitis, developed bilateral omalgia, petechiae on his lower extremities and a congested right eye. A blood test detected elevated serum C-reactive protein level. Computed tomography incidentally found an acute lesion of thalamic hemorrhage without neurological symptoms and no specific therapy was given at the time. Thereafter, he developed vertigo, vomiting and pneumonia for which antibiotics were ineffective. He was referred and admitted to our hospital. Further, aural and renal lesions, and presence of serum proteinase 3-antineutrophil cytoplasmic antibody (PR3-ANCA) confirmed his diagnosis of granulomatosis with polyangiitis (Wegener's) (GPA). With corticosteroid and cyclophosphamide therapy, his symptoms disappeared in two months along with faded PR3-ANCA. Afterward he showed neither new cerebral lesion nor symptom. This is a rare case of GPA manifested with asymptomatic intracerebral hemorrhage. It should be noted that GPA could cause various manifestations in central nervous system such as a fatal or an asymptomatic hemorrhagic lesion, which might respond to immunosuppressive therapy.<br>

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