Granulomatosis with polyangiitis physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Ali Poyan Mehr, M.D. [2]Associate Editor(s)-in-Chief: Amandeep Singh M.D.[3]Krzysztof Wierzbicki M.D. [4]
Overview
The important physical exam findings are Ulcerations, palpable purpura and subcutaneous nodules in the skin; conjunctivitis, uveitis, sinusitis, purulent exudate from nares,saddle nose deformity, reduced hearing in the head and neck; pleuritic chest pain ans signs of atelectasis in lung examination; and signs of mononeuritis multiplex on neural exam.
Physical Examination
- Physical examination of patients with Granulomatosis with polyangiitis is usually remarkable for:[1][2]
Vital Signs
- They usually have normal vital signs until infected.
Skin
The skin findings are seen in 14% of patients:[3]
- Ulcerations
- Palpable purpura
- Subcutaneous nodules
HEENT
- Scleritis
- Keratitis
- Uveitis
- Conjunctivitis
- Proptosis
- Xanthelasma
- Purulent exudate from the nares
- Sinusitis[4]
- Saddle nose deformity
- Otitis Media
- Hearing acuity may be reduced[1]
- Weber test may be abnormal
- Rinne test may be positive
- Gingival hyperplasia or necrotizing gingivitis[5] can be seen
Neck
- Neck examination of patients with granulomatosis with polyangiitis is usually normal.
Lungs
Examination may show signs of:
- Pleuritic pain
- Atelectasis
- Pleural effusion
- Pulmonary hypertension- bibasilar crackles
- Subglottic stenosis
Heart
Abdomen
- Abdominal tenderness may be present[6]
- Guarding may be present
Back
- Back examination of patients with granulomatosis with polyangiitis is usually normal.
Genitourinary
- A pelvic/adnexal mass may be palpated
- Inflamed mucosa
Neuromuscular
- Patient is usually oriented to persons, place, and time
- Mononeuritis multiplex[7]- Loss of sensory and motor functions
- Cranial nerve paralysis
Extremities
- Extremities examination of patients with granulomatosis with polyangiitis is usually normal.
References
- ↑ 1.0 1.1 Seo P, Stone JH (July 2004). "The antineutrophil cytoplasmic antibody-associated vasculitides". Am. J. Med. 117 (1): 39–50. doi:10.1016/j.amjmed.2004.02.030. PMID 15210387.
- ↑ Graves N (October 2006). "Wegener granulomatosis". Proc (Bayl Univ Med Cent). 19 (4): 342–4. PMC 1618758. PMID 17106496.
- ↑ Daoud MS, Gibson LE, DeRemee RA, Specks U, el-Azhary RA, Su WP (October 1994). "Cutaneous Wegener's granulomatosis: clinical, histopathologic, and immunopathologic features of thirty patients". J. Am. Acad. Dermatol. 31 (4): 605–12. PMID 8089286.
- ↑ Cannady SB, Batra PS, Koening C, Lorenz RR, Citardi MJ, Langford C, Hoffman GS (April 2009). "Sinonasal Wegener granulomatosis: a single-institution experience with 120 cases". Laryngoscope. 119 (4): 757–61. doi:10.1002/lary.20161. PMID 19263410.
- ↑ Genuis K, Pewarchuk J (September 2014). "Granulomatosis with polyangiitis (Wegener's) as a necrotizing gingivitis mimic: a case report". J Med Case Rep. 8: 297. doi:10.1186/1752-1947-8-297. PMC 4168997. PMID 25196320.
- ↑ Pagnoux C, Mahr A, Cohen P, Guillevin L (March 2005). "Presentation and outcome of gastrointestinal involvement in systemic necrotizing vasculitides: analysis of 62 patients with polyarteritis nodosa, microscopic polyangiitis, Wegener granulomatosis, Churg-Strauss syndrome, or rheumatoid arthritis-associated vasculitis". Medicine (Baltimore). 84 (2): 115–28. PMID 15758841.
- ↑ Anadure R, Narayanan C, Varadraj G, Nandeesh B (January 2017). "ANCA Associated Mononeuritis Multiplex with Overlap in Vasculitic Syndromes". J Clin Diagn Res. 11 (1): OD01–OD03. doi:10.7860/JCDR/2017/22252.9149. PMC 5324437. PMID 28273992.