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: Krzysztof Wierzbicki M.D. [3]

Overview

A complete medical history and a comprehensive renal, pulmonary, and ENT examination must be preformed to help identify and properly diagnose Granulomatosis with polyangiitis from other diseases.

Cranial nerve paralysis

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
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^[4] can be seen

Neck

Neck examination of patients with granulomatosis with polyangiitis is usually normal

Lungs

Asymmetric chest expansion / Decreased chest expansion
Lungs are hypo/hyperresonant
Fine/coarse crackles upon auscultation of the lung bases/apices unilaterally/bilaterally
Rhonchi
Vesicular breath sounds / Distant breath sounds
Expiratory/inspiratory wheezing with normal / delayed expiratory phase
Wheezing may be present
Egophony present/absent
Bronchophony present/absent
Normal/reduced tactile fremitus
Atelectasis
Pleural effusion

Heart

Abdomen

Abdominal examination of patients with [disease name] is usually normal.

OR

Abdominal distention
Abdominal tenderness in the right/left upper/lower abdominal quadrant
Rebound tenderness (positive Blumberg sign)
A palpable abdominal mass in the right/left upper/lower abdominal quadrant
Guarding may be present
Hepatomegaly / splenomegaly / hepatosplenomegaly
Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test

Back

Back examination of patients with [disease name] is usually normal.

Genitourinary

Genitourinary examination of patients with [disease name] is usually normal.

OR

A pelvic/adnexal mass may be palpated
Inflamed mucosa
Clear/(color), foul-smelling/odorless penile/vaginal discharge

Neuromuscular

Patient is usually oriented to persons, place, and time
Mononeuritis multiplex- Loss of sensory and motor functions

Extremities

Extremities examination of patients with [disease name] 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.
↑ 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.

[pmid15210387-1] 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.

[pmid17106496-2] Graves N (October 2006). "Wegener granulomatosis". Proc (Bayl Univ Med Cent). 19 (4): 342–4. PMC 1618758. PMID 17106496.

[pmid8089286-3] 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.

[pmid251963202-4] 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.

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